Provider Demographics
NPI:1497640593
Name:KELLER, DAVETTE
Entity type:Individual
Prefix:
First Name:DAVETTE
Middle Name:
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 1:4009 W 49TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-5221
Mailing Address - Country:US
Mailing Address - Phone:218-336-4948
Mailing Address - Fax:833-660-2069
Practice Address - Street 1:4009 W 49TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-5221
Practice Address - Country:US
Practice Address - Phone:218-336-4948
Practice Address - Fax:833-660-2069
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID27653163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management