| Doctor Name: | WILLIAM H KELLERMEYER |
| NPI Number: | 1043692460 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | 71005503A |
| Business Practice Address: | 2401 W University Ave Muncie, IN - 473033428 |
| Business Phone Number: | 7657511720 |
| Business Fax Number: | 7657412961 |
| Mailing Address: | 250 N Shadeland Ave, Suite 130, Provider Enrollment INDIANAPOLIS |
| State: | IN |
| Postal Code: | 462194959 |
| Phone Number: | 3179624777 |
| Fax Number: | 3179620861 |
| NPI Enumeration Date: | 06/22/2015 |
| NPI Last Update Date: | 11/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71005503A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |