Provider Demographics
NPI:1932735602
Name:KEELER, ALICIA LYNNE (CNA, PEER SPECIALIST)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNNE
Last Name:KEELER
Suffix:
Gender:F
Credentials:CNA, PEER SPECIALIST
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:LYNNE
Other - Last Name:KEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA, PEER SPECIALIST
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0204
Mailing Address - Country:US
Mailing Address - Phone:360-324-9489
Mailing Address - Fax:
Practice Address - Street 1:228 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356
Practice Address - Country:US
Practice Address - Phone:360-330-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60680389376K00000X
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No376K00000XNursing Service Related ProvidersNurse's Aide