Provider Demographics
NPI:1265784078
Name:KELLER, KAREN G (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:G
Last Name:KELLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELIZABETH PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3445
Mailing Address - Country:US
Mailing Address - Phone:937-660-7070
Mailing Address - Fax:938-660-3111
Practice Address - Street 1:2449 ROSS MILLVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-8951
Practice Address - Country:US
Practice Address - Phone:513-856-7360
Practice Address - Fax:513-856-7358
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily