Individual
MS. COURTNEY ANN KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
9165 W THUNDERBIRD RD SUITE 201, PEORIA, AZ 85381-4847
(623) 876-8420
(623) 285-2626
Mailing address
9165 W THUNDERBIRD RD SUITE 201, PEORIA, AZ 85381-4847
(623) 876-8420
(623) 285-2626
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP7558
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN173592
AZ
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
46
ND
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
46
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054517
—
ND
05
—
979757
—
AZ
01
—
PENDING
TRICARE
ND
Enumeration date
05/27/2008
Last updated
10/28/2020
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