Individual
KIERA KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 S ORANGE AVE STE 170, LIVINGSTON, NJ 07039-5817
(973) 867-8388
Mailing address
54 BRANFORD RD, WHIPPANY, NJ 07981-1323
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021414
—
NY
05
—
25MP00452400
—
NJ
Enumeration date
09/27/2017
Last updated
10/20/2017
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