Healthcare Provider Details

I. General information

NPI: 1467906990
Provider Name (Legal Business Name): KELLIE D KEEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N EL DORADO PL # E520
TUCSON AZ
85715-4637
US

IV. Provider business mailing address

6460 E GRANT RD UNIT 30118
TUCSON AZ
85751-4006
US

V. Phone/Fax

Practice location:
  • Phone: 520-526-2325
  • Fax: 520-526-2837
Mailing address:
  • Phone: 520-637-3362
  • Fax: 520-526-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberAP8917
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8917
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: