Provider Demographics
NPI:1952448227
Name:KELLER, BARBRA J (FNP-C)
Entity Type:Individual
Prefix:
First Name:BARBRA
Middle Name:J
Last Name:KELLER
Suffix:
Gender:F
Credentials:FNP-C
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 148
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL ISLAND
Mailing Address - State:AK
Mailing Address - Zip Code:99660-0148
Mailing Address - Country:US
Mailing Address - Phone:907-546-8300
Mailing Address - Fax:907-546-8370
Practice Address - Street 1:1000 POLOVINA
Practice Address - Street 2:
Practice Address - City:ST PAUL ISLAND
Practice Address - State:AK
Practice Address - Zip Code:99660
Practice Address - Country:US
Practice Address - Phone:907-546-8300
Practice Address - Fax:907-546-8370
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKP92496Medicare UPIN
AK152653Medicare ID - Type Unspecified