Provider Demographics
NPI:1902271406
Name:KELLER, SHAWANE (NP-C)
Entity Type:Individual
Prefix:
First Name:SHAWANE
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHAWANE
Other - Middle Name:
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4520 WICHERS DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3135
Mailing Address - Country:US
Mailing Address - Phone:504-754-2334
Mailing Address - Fax:504-324-2078
Practice Address - Street 1:4520 WICHERS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3135
Practice Address - Country:US
Practice Address - Phone:504-754-2334
Practice Address - Fax:504-324-2078
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP.08395363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner