Provider Demographics
NPI:1174792618
Name:KELLER, JOY (CDM)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7316
Mailing Address - Country:US
Mailing Address - Phone:907-456-3719
Mailing Address - Fax:907-456-1511
Practice Address - Street 1:2054 30TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7316
Practice Address - Country:US
Practice Address - Phone:907-456-3719
Practice Address - Fax:907-456-1511
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA54176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife