Provider Demographics
NPI:1427782861
Name:KELLER, MARY (PMHNP-BC, RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JULIAN LN STE 640
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7812
Mailing Address - Country:US
Mailing Address - Phone:828-552-3504
Mailing Address - Fax:
Practice Address - Street 1:600 JULIAN LN STE 640
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7812
Practice Address - Country:US
Practice Address - Phone:828-552-3504
Practice Address - Fax:828-552-3505
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN311520163WP0809X
NC5019419363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult