Individual
DR. NANCY KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
790 E 5TH ST, COQUILLE, OR 97423-1755
(541) 396-3111
(541) 396-5891
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD18038
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043831
—
OR
01
—
080041637
RR MEDICARE PTAN NUMBER
OR
01
—
1407812365
NBMC NPI NUMBER-GROUP
OR
01
—
CD8723
RR MEDICARE GROUP NUMBER
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
12/06/2005
Last updated
03/23/2010
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