Provider Demographics
NPI:1619677721
Name:KELLER, ASHLEY DYLAN (PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:DYLAN
Last Name:KELLER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 NE KAMIAKEN ST.
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:WA
Mailing Address - Zip Code:99179-0082
Mailing Address - Country:US
Mailing Address - Phone:425-765-4303
Mailing Address - Fax:
Practice Address - Street 1:167 NE KAMIAKEN ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2611
Practice Address - Country:US
Practice Address - Phone:509-595-5579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID72930163WC0200X
WAAP70000179363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine