BART R KELLER (NPI# 1679571475) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679571475 |
| Entity Type | Individual |
| Full Name | BART R KELLER |
| Credential | PA-C |
| Practice Address |
410 S Wilcox St Castle Rock CO 80104-2662 |
| Practice Telephone | 3036886900 |
| Practice Fax Number | 3036606504 |
| Mailing Telephone | 3036886900 |
| Mailing Fax Number | 3036606504 |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2018-02-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA.0003377 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
5601002360 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | MK0941612 | 01 |
| Street Address |
410 S WILCOX ST |
| City | CASTLE ROCK |
| State | CO |
| Zip Code | 80104-2662 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124650320 | Tri-county Health Department | Clinic/Center | 410 S Wilcox St, Castle Rock, CO 80104-2662 | 2020-02-06 |
| 1538569017 | Kaitlyn Cooper Brock | Counselor | 410 S Wilcox St, Castle Rock, CO 80104 | 2014-09-03 |
| 1205930302 | David C Simon | Pediatrics | 410 S Wilcox St, Castle Rock, CO 80104-2662 | 2006-09-11 |
| 1144252602 | Douglas Medical PC | Family Medicine | 410 S Wilcox St, Castle Rock, CO 80104-2662 | 2006-07-07 |
| 1245210301 | Larry L. Odekirk | Family Medicine | 410 S Wilcox St, Castle Rock, CO 80104-2662 | 2006-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932737152 | F2dis, Limited Liability Company | Skilled Nursing Facility | 1055 S. Perry Street, Castle Rock, CO 80104 | 2020-04-01 |
| 1518497262 | Courtney Renee Mcmurtry | Dental Hygienist | 610 E. Fifth St., Suite 300, Castle Rock, CO 80104 | 2017-06-15 |
| 1235598350 | Village Physical Therapy, PC | Specialist | 1184 South Perry Street, Suite 230, Castle Rock, CO 80104 | 2016-02-17 |
| 1730513318 | Erin Evers | Physical Therapist | 4348 Woodlands Boulevard, Suite 100, Castle Rock, Co, CO 80104 | 2013-08-30 |
| 1730424185 | Ange' Anesthesia | Nurse Anesthetist, Certified Registered | 157 Crosshaven Pl, Castle Rock, CO 80104 | 2012-12-11 |
| 1902155013 | Rachel Everett | Marriage & Family Therapist | 831 S Perry Street, Suite 100, Castle Rock, CO 80104 | 2012-09-05 |
| 1922366889 | Health Connections of Castle Rock, Inc. | Massage Therapist | 323 Metzler Dr #105, Castle Rock, CO 80104 | 2012-04-30 |
| 1326313255 | Kate Ivey | Counselor | 4889 Thorndike Ave, Castle Rock, CO 80104 | 2012-03-10 |
| 1902106578 | Gordon Talmadge Blair IIi | Physical Therapist | 814 S. Perry St., Suit 101, Castle Rock, CO 80104 | 2010-10-28 |
| 1285943936 | Denise L Lucia | Psychologist | 509 Wilcox Street, Suite 101, Castle Rock, CO 80104 | 2010-09-29 |
| Find all providers in zip 80104 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467072934 | Panorama Orthopedics & Spine Center, PC | Physician Assistant | 4350 Limelight Ave Ste 100, Castle Rock, CO 80109-8034 | 2020-04-24 |
| 1255791059 | Jessica Branson | Physician Assistant | 755 S Perry St Ste 100, Castle Rock, CO 80104-1923 | 2016-03-07 |
| 1396175212 | Hollie M Reda | Physician Assistant | 4404 Barranca Ln, Castle Rock, CO 80104-7432 | 2013-11-13 |
| 1073941159 | Ashley Weigle | Physician Assistant | 4386 Trail Boss Dr Ste A, Castle Rock, CO 80104-7512 | 2013-10-28 |
| 1194066043 | Jennifer A Walker | Physician Assistant | 4318 Trail Boss Dr Ste 100, Castle Rock, CO 80104-7512 | 2013-03-01 |
| 1144533522 | Tammy Joy Garrett | Physician Assistant | 4000 Justice Way, Castle Rock, CO 80109-7802 | 2010-07-14 |
| 1417283722 | Amy Lynne Ossian | Physician Assistant | 1001 S Perry St Ste 101b, Castle Rock, CO 80104-1921 | 2009-10-20 |
| 1558507087 | Jocelyn Cavender | Physician Assistant | 4404 Barranca Ln Unit 101, Castle Rock, CO 80104-7432 | 2009-01-06 |
| 1396943395 | Kristie B. Borne | Physician Assistant | 2356 Meadows Blvd Ste 340, Castle Rock, CO 80109-8410 | 2007-07-11 |
| 1720065956 | Carrie A Meyer | Physician Assistant | 2352 Meadows Blvd Ste 145, Castle Rock, CO 80109-8406 | 2005-12-29 |
| Find all providers in CASTLE ROCK | ||||
| City | CASTLE ROCK |
| Zip Code | 80104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.