Provider Demographics
NPI:1366745713
Name:KELLER, JEANETTE MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:KELLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:MARIE
Other - Last Name:VANDERBOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 1257
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1257
Mailing Address - Country:US
Mailing Address - Phone:573-248-1300
Mailing Address - Fax:573-406-5889
Practice Address - Street 1:3650 STARDUST DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2480
Practice Address - Country:US
Practice Address - Phone:573-629-3400
Practice Address - Fax:573-231-0660
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010040482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily