Individual
MR. CHAD J KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSED, BSN, RN, ATC
Contact information
Practice address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 685-2221
Mailing address
2232 S MICHELLE ST, WICHITA, KS 67207-6690
(913) 850-8388
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
13-116483-012
KS
2255A2300X
Athletic Trainer
24-00315
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13-116483-012
KANSAS STATE BOARD OF NURSING (REGISTERED NURSE)
KS
01
—
24-00315
KANSAS STATE BOARD OF HEALING ARTS (ATHLETIC TRAINER) AT
KS
Enumeration date
02/15/2006
Last updated
01/03/2015
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