Provider Demographics
NPI:1437138286
Name:KELLER, VALERIE S (PA-C)
Entity type:Individual
Prefix:MR
First Name:VALERIE
Middle Name:S
Last Name:KELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-7947
Mailing Address - Country:US
Mailing Address - Phone:304-424-4760
Mailing Address - Fax:304-424-4761
Practice Address - Street 1:362 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-7947
Practice Address - Country:US
Practice Address - Phone:304-991-8399
Practice Address - Fax:304-200-2057
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV922363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVKEPA22932Medicare ID - Type Unspecified
WVP94756Medicare UPIN