1811332588 NPI number — MRS. AMI MARIE KELTNER C.R.N.A.

Table of content: MRS. AMI MARIE KELTNER C.R.N.A. (NPI 1811332588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811332588 NPI number — MRS. AMI MARIE KELTNER C.R.N.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELTNER
Provider First Name:
AMI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHERMAN
Provider Other First Name:
AMI
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811332588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2604 WHITMORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66046-5300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-225-9318
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7111 FAIRWAY DR
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
PALM BEACH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33418-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-623-2054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  2007019207 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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