Active NPI
Dianne Keller, M.D.
- Addiction Psychiatry Physician
- Tucson, AZ
National Provider Identifier
1902996150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Psychiatry Physician
- License
- 20611
- Practice address
- 2502 N Dodge Blvd
Suite 190
Tucson, AZ 85716-2671 - Phone
- (520) 490-4266
- Fax
- (520) 617-1608
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction Psychiatry Physician | 2084P0802X | 20611 | AZ | Primary |
Addresses
Primary practice location
2502 N Dodge Blvd
Suite 190
Tucson, AZ 85716-2671
Mailing address
2502 N Dodge Blvd
Suite 190
Tucson, AZ 85716-2671
Phone (520) 490-4266
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113324 | Medicaid | AZ |
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 |
|---|---|---|---|
| 20611 | AZ | MD | Addiction Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297987200000",
"number": "1902996150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2502 N DODGE BLVD",
"address_2": "SUITE 190",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857162671",
"telephone_number": "520-490-4266",
"fax_number": "520-617-1608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2502 N DODGE BLVD",
"address_2": "SUITE 190",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857162671",
"telephone_number": "520-490-4266",
"fax_number": "520-617-1608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "DIANNE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2011-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0802X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Psychiatry",
"state": "AZ",
"license": "20611",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "113324",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.