Provider Demographics
NPI:1588173520
Name:KELLER, JOSHUA DAVID (FNP-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:KELLER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LAKOTA CT
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3755
Mailing Address - Country:US
Mailing Address - Phone:210-632-5519
Mailing Address - Fax:
Practice Address - Street 1:201 LAKOTA CT
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3755
Practice Address - Country:US
Practice Address - Phone:210-632-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily