Individual provider · Type 1 NPI

Kelly Rene Keller, PA

Medical Physician Assistant · Portland, OR

NPI number 1093916744 Active

Practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Call (503) 418-5710 Map

Fax (503) 494-4953

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XPA04395 (TX)
Medical Physician Assistant Primary 363AM0700XPA152808 (OR)

Medical Physician Assistant: Definition to come...

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About NPI 1093916744

Kelly Rene Keller, PA's National Provider Identifier is 1093916744, issued on May 30, 2007. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Portland, OR. The record was last updated on Dec 29, 2020.