Provider Demographics
NPI:1801387451
Name:KELLER, REBEKAH DIANE (MD)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:DIANE
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-8200
Mailing Address - Fax:314-454-5244
Practice Address - Street 1:740 S LIMESTONE STE B200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1032
Practice Address - Country:US
Practice Address - Phone:859-257-3533
Practice Address - Fax:859-218-7693
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY59992208800000X
MO2023010939208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200122003Medicaid