Active NPI
Jennifer Nicole Keller, P.T.
- Specialist
- Poway, CA
National Provider Identifier
1922033828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT29944
- Practice address
- 15525 Pomerado Rd
Ste D4
Poway, CA 92064-2435 - Phone
- (858) 674-1600
- Fax
- (858) 674-1606
- NPI assigned
- Jul 11, 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 |
|---|---|---|---|---|
| Specialist | 174400000X | PT29944 | CA | Primary |
Addresses
Primary practice location
15525 Pomerado Rd
Ste D4
Poway, CA 92064-2435
Mailing address
PO Box 28199
San Diego, CA 92198-0199
Phone (858) 675-3100
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29944 | CA | MD | General Practice Dentistry |
| PT29944 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398297600000",
"number": "1922033828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 28199",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921980199",
"telephone_number": "858-675-3100",
"fax_number": "858-618-1523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15525 POMERADO RD",
"address_2": "STE D4",
"city": "POWAY",
"state": "CA",
"postal_code": "920642435",
"telephone_number": "858-674-1600",
"fax_number": "858-674-1606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "JENNIFER",
"middle_name": "NICOLE",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-11",
"last_updated": "2014-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "PT29944",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poway, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.