Individual
KRISTY KELLER PARENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8300 CONSTANTIN BLVD, BATON ROUGE, LA 70809-3489
(225) 374-1410
(225) 374-1616
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0011
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
200187
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07801816
—
MS
05
—
1170526
—
LA
Enumeration date
07/21/2008
Last updated
06/07/2021
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