Provider Demographics
NPI:1831078658
Name:KELLER, AUNDRAYA LYNNET
Entity type:Individual
Prefix:MS
First Name:AUNDRAYA
Middle Name:LYNNET
Last Name:KELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AUNDRAYA
Other - Middle Name:LYNNET
Other - Last Name:CHIDESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42436 TIGERS EYE STONE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-6437
Mailing Address - Country:US
Mailing Address - Phone:225-287-4188
Mailing Address - Fax:
Practice Address - Street 1:42436 TIGERS EYE STONE AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-6437
Practice Address - Country:US
Practice Address - Phone:225-287-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN153825163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient