Individual
CAROL A KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
137 JPM RD, LEWISBURG, PA 17837-9313
(570) 523-3937
Mailing address
238 N 2ND ST, LEWISBURG, PA 17837-1518
(570) 523-7295
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA000908L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
095071
—
PA
01
—
50012607
CAPITAL BLUE
PA
Enumeration date
09/26/2006
Last updated
07/09/2007
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