Provider Demographics
NPI:1215429477
Name:KEILLOR, AMY DIANE (CPM)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:KEILLOR
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10838 HEAVEN SCENT LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-2801
Mailing Address - Country:US
Mailing Address - Phone:502-442-3858
Mailing Address - Fax:877-827-9795
Practice Address - Street 1:10838 HEAVEN SCENT LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2801
Practice Address - Country:US
Practice Address - Phone:502-442-3858
Practice Address - Fax:877-827-9795
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife