Provider Demographics
NPI:1548520547
Name:KELLAR, ANITRA E (REGISTERED PROFESSIO)
Entity type:Individual
Prefix:MS
First Name:ANITRA
Middle Name:E
Last Name:KELLAR
Suffix:
Gender:F
Credentials:REGISTERED PROFESSIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NY
Mailing Address - Zip Code:13634-0414
Mailing Address - Country:US
Mailing Address - Phone:315-918-4019
Mailing Address - Fax:
Practice Address - Street 1:1 CHIMNEY POINT DR
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-2201
Practice Address - Country:US
Practice Address - Phone:315-541-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606015-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse