Organization
VAMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON SCOTT KELLER PA (PHYSICIAN ASST)
(479) 443-4301
Entity
Organization
Contact information
Practice address
1100 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1944
(479) 443-4301
(479) 587-5996
Mailing address
1621 N CHARLEE AVE, FAYETTEVILLE, AR 72703-3066
(479) 444-7376
(479) 587-5996
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
PA140
AR
Other
Enumeration date
08/23/2006
Last updated
08/22/2020
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