Provider Demographics
NPI:1194046565
Name:KELLER, PATRICIA L (FNP-C, LNS, RN, SANE)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:KELLER
Suffix:
Gender:F
Credentials:FNP-C, LNS, RN, SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 N GRANT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3850 N GRANT AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-624-5170
Practice Address - Fax:970-669-7521
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily