Provider Demographics
NPI:1922574938
Name:KELLER, SILENCE TIA (NP)
Entity Type:Individual
Prefix:
First Name:SILENCE
Middle Name:TIA
Last Name:KELLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-996-8478
Mailing Address - Fax:812-996-8497
Practice Address - Street 1:26020 STATE ROAD 145
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:IN
Practice Address - Zip Code:47515-8865
Practice Address - Country:US
Practice Address - Phone:812-357-2099
Practice Address - Fax:812-357-2097
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008549A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily