Provider Demographics
NPI:1972860815
Name:KELLER, KATRINA N (ARNP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:N
Last Name:KELLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 E 57TH AVE # 5-329
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7028
Mailing Address - Country:US
Mailing Address - Phone:509-535-1143
Mailing Address - Fax:866-488-6520
Practice Address - Street 1:2910 E 57TH AVE # 5-329
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7028
Practice Address - Country:US
Practice Address - Phone:509-535-1143
Practice Address - Fax:866-488-6520
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60284256363L00000X, 363LP2300X
VAAP60284256363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner