Provider Demographics
NPI:1164955639
Name:KELLER, ELIZABETH KAY (MSN, NP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:KELLER
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 CHAPARRAL CIR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7698
Mailing Address - Country:US
Mailing Address - Phone:805-234-8985
Mailing Address - Fax:
Practice Address - Street 1:1485 KANSAS AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405
Practice Address - Country:US
Practice Address - Phone:805-754-2037
Practice Address - Fax:805-357-6509
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily