Provider Demographics
NPI:1649505082
Name:KELLER, PHILIP A (PA)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:KELLER
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Gender:M
Credentials:PA
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Mailing Address - Street 1:4300 SAPPHIRE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9079
Mailing Address - Country:US
Mailing Address - Phone:252-830-7561
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:2808 S CROATAN HWY
Practice Address - Street 2:SUITE 565
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9024
Practice Address - Country:US
Practice Address - Phone:252-441-2324
Practice Address - Fax:252-441-1994
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2015-07-20
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Provider Licenses
StateLicense IDTaxonomies
NC102305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant