Individual
DALE V KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
12218 NICKLAUS RD, SANDY, UT 84092-5937
(801) 502-7386
Mailing address
12218 NICKLAUS RD, SANDY, UT 84092-5937
(801) 502-7386
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2239484405
UT
Other
Enumeration date
04/25/2006
Last updated
04/27/2016
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