Provider Demographics
NPI:1447957725
Name:KELLER, KIMBERLY KAY (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:KELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67025-9030
Mailing Address - Country:US
Mailing Address - Phone:316-633-2867
Mailing Address - Fax:316-634-3057
Practice Address - Street 1:517 ALLISON DR
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:KS
Practice Address - Zip Code:67025-9030
Practice Address - Country:US
Practice Address - Phone:316-633-2867
Practice Address - Fax:316-634-3057
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS80535-011163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology