Provider Demographics
NPI:1023680832
Name:KELLER, LAURIE LEIGH
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:LEIGH
Last Name:KELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 LESTER ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-8709
Mailing Address - Country:US
Mailing Address - Phone:304-222-0838
Mailing Address - Fax:
Practice Address - Street 1:133 LESTER ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-8709
Practice Address - Country:US
Practice Address - Phone:304-222-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant