Individual
JARED BRENT KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
402 6TH ST, RUPERT, ID 83350-1619
(208) 650-7941
(208) 436-0735
Mailing address
794 EASTLAND DR, TWIN FALLS, ID 83301-6856
(208) 737-6718
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1256
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013041111
MISSOURI LICENSE 2013041111
MO
Enumeration date
11/19/2013
Last updated
03/17/2021
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