Provider Demographics
NPI:1386327211
Name:KELLER, JULIE BETH (NBC-HWC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:BETH
Last Name:KELLER
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-0651
Mailing Address - Country:US
Mailing Address - Phone:304-279-8251
Mailing Address - Fax:
Practice Address - Street 1:76 RICHARD ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-0651
Practice Address - Country:US
Practice Address - Phone:304-279-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-3783780171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach