Provider Demographics
NPI:1033910989
Name:KELLER, EDWEANA KATRICE (FNP-C)
Entity type:Individual
Prefix:
First Name:EDWEANA
Middle Name:KATRICE
Last Name:KELLER
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1109
Mailing Address - Country:US
Mailing Address - Phone:336-420-1055
Mailing Address - Fax:
Practice Address - Street 1:2400 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1109
Practice Address - Country:US
Practice Address - Phone:336-420-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily