Individual
LOGAN J KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2770 3RD AVE STE 110, LAKE CHARLES, LA 70601-0404
(337) 494-4747
(337) 494-4773
Mailing address
P O BOX 122425 DEPT 2425, DALLAS, TX 75312-2425
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP08215
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2385810
—
LA
01
—
AP08215
STATE NP LICENSE
LA
Enumeration date
02/24/2015
Last updated
04/27/2022
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