Provider Demographics
NPI:1154058220
Name:KELLER, LAURA LYNN (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:KELLER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E FAWN DR
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-3659
Mailing Address - Country:US
Mailing Address - Phone:121-772-2684
Mailing Address - Fax:
Practice Address - Street 1:1001 HEATHER DR
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-2754
Practice Address - Country:US
Practice Address - Phone:217-586-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041369089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily