Individual
MARY KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, RN
Contact information
Practice address
24 CHECHERO ST STE 2, CLAYTON, GA 30525-6181
(706) 963-0654
(706) 973-4087
Mailing address
12244 AUGUSTA RD UNIT 108, LAVONIA, GA 30553-1210
(706) 963-0654
(706) 973-4087
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
RN311520
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5019419
NC
Other
Enumeration date
07/12/2022
Last updated
01/21/2026
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