Mary Jean Keller, RN, NP
Individual provider Active NPI Family Nurse Practitioner · Linthicum Heights, MD
NPI 1073678033 · NPPES record last updated Jun 10, 2024
Key facts
- NPI
- 1073678033
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 091099 (MO)
- Practice address
- Mary Keller
785 Elkridge Landing Suite #300
Linthicum Heights, MD 21090 - Phone
- (417) 379-7253
- Fax
- (844) 464-0583
- NPI assigned
- Dec 27, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 091099 | MO | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 091099 | MO | Yes |
Addresses
Primary practice location
Mary Keller
785 Elkridge Landing Suite #300
Linthicum Heights, MD 21090
Mailing address
PO Box 4046
Springfield, MO 65808-4046
Phone (417) 269-5712
Other practice location 1
3525 S National Ave Ste 207
Springfield, MO 65807-7315
Phone (417) 269-9220
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00635675 | Other | MO | TRAVELERS RR MEDICARE |
| 171101758 | Medicaid | AR | |
| 1073678033 | Medicaid | MO | |
| 431560263 | Other | MO | TRICARE WEST |
Other providers in Linthicum Heights, MD
- Imperial Mentoring
- Imperial Mentoring
- Ion Occupational Medical Consultants
- Carolyn Jendrek
- Mildred E Kangkolo
- Darius Kelley
- Priyana Kumar Khan
- Bayan Kozalbash
- Tasneem Lakhani
- Makayla Lee
All providers in Linthicum Heights, MD · Family Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.