Active NPI
Nancy Keller, MD
- Family Medicine Physician
- Coquille, OR
National Provider Identifier
1063496602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD18038
- Practice address
- 790 E 5TH St
Coquille, OR 97423-1755 - Phone
- (541) 396-3111
- Fax
- (541) 396-5891
- NPI assigned
- Dec 6, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD18038 | OR | Primary |
Addresses
Primary practice location
790 E 5TH St
Coquille, OR 97423-1755
Mailing address
1900 Woodland Dr
Coos Bay, OR 97420-0000
Phone (541) 267-5151
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R0000WFBTV | Other | OR | MEDICARE GROUP PIN NUMBER |
| 080041637 | Other | OR | RR MEDICARE PTAN NUMBER |
| CD8723 | Other | OR | RR MEDICARE GROUP NUMBER |
| 1407812365 | Other | OR | NBMC NPI NUMBER-GROUP |
| 043831 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18038 | OR | MD | Reflexologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269302400000",
"number": "1063496602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 WOODLAND DR",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974200000",
"telephone_number": "541-267-5151",
"fax_number": "541-266-4501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 E 5TH ST",
"city": "COQUILLE",
"state": "OR",
"postal_code": "974231755",
"telephone_number": "541-396-3111",
"fax_number": "541-396-5891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "NANCY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-06",
"last_updated": "2010-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD18038",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PIN NUMBER",
"identifier": "R0000WFBTV",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PTAN NUMBER",
"identifier": "080041637",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP NUMBER",
"identifier": "CD8723",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NBMC NPI NUMBER-GROUP",
"identifier": "1407812365",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "043831",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coquille, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.