Provider Demographics
NPI:1114662343
Name:KELLER, RYAN PATRICK (CRNP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:KELLER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3683
Mailing Address - Country:US
Mailing Address - Phone:855-687-2410
Mailing Address - Fax:
Practice Address - Street 1:300 W BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3683
Practice Address - Country:US
Practice Address - Phone:558-687-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025672363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health