Provider Demographics
NPI:1194536979
Name:ELROD, KEELY ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:KEELY
Middle Name:ANN
Last Name:ELROD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WARD AVE
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-1661
Mailing Address - Country:US
Mailing Address - Phone:573-479-3036
Mailing Address - Fax:573-922-5038
Practice Address - Street 1:501 WARD AVE
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-1661
Practice Address - Country:US
Practice Address - Phone:573-479-3036
Practice Address - Fax:573-922-5038
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018016287164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse