Provider Demographics
NPI:1730205196
Name:KELLER, LAUREN CHRISTINE (CNM)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:CHRISTINE
Last Name:KELLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ASHTON PARK
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3663
Mailing Address - Country:US
Mailing Address - Phone:901-651-3944
Mailing Address - Fax:
Practice Address - Street 1:126 ASHTON PARK
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3663
Practice Address - Country:US
Practice Address - Phone:901-651-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.019354363L00000X
VT101.0134214367A00000X
CT410367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNM.019354OtherAPRN LICENSE