Keller, Stacy A
Keller, Stacy A is an individual health care provider with primary practice located at 705 Riley Hospital Dr Roc 4210, Indianapolis IN 46202-5109. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Keller, Stacy A can be contacted via phone (317) 944-3774.Contact Information
Primary practice address
705 Riley Hospital Dr Roc 4210
Indianapolis IN 46202-5109
Phone: (317) 944-3774
Fax: (317) 944-8521
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | 71001660 | Indiana |
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | 28121823 | Indiana |
Profile Details
| NPI number | 1053493320 |
|---|---|
| LBN Legal business name | Keller, Stacy A |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 19th, 2006 |
| Last updated | Oct 14th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053493320 | NPPES |
| Indiana | MEDICAID | 200467770 |
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