Individual
MRS. ANDREA LYNN KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
3301 WOODBURN RD, SUITE 209, ANNANDALE, VA 22003-1229
(703) 698-9254
(703) 698-9256
Mailing address
3301 WOODBURN RD, SUITE 209, ANNANDALE, VA 22003-1229
(703) 698-9254
(703) 698-9256
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110003314
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13101003000527
CMS/MEDICATE PECOS
VA
Enumeration date
07/30/2010
Last updated
04/29/2013
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