Provider Demographics
NPI:1295105930
Name:KELLER, WILLIAM (FNP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 COUNTY ROAD 289
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-9172
Mailing Address - Country:US
Mailing Address - Phone:540-461-2625
Mailing Address - Fax:
Practice Address - Street 1:310 BUTTERCUP DR STE A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2932
Practice Address - Country:US
Practice Address - Phone:870-508-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily