Provider Demographics
NPI:1124907936
Name:KELLER, JAMIE DEE (LVN, BCPA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:DEE
Last Name:KELLER
Suffix:
Gender:F
Credentials:LVN, BCPA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DEE
Other - Last Name:DURKOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1209 RITTER DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1626
Mailing Address - Country:US
Mailing Address - Phone:512-484-5656
Mailing Address - Fax:737-221-5726
Practice Address - Street 1:1209 RITTER DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1626
Practice Address - Country:US
Practice Address - Phone:512-484-5656
Practice Address - Fax:737-221-5726
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
TX211151164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No372600000XNursing Service Related ProvidersAdult Companion