Healthcare Provider Details

I. General information

NPI: 1255240024
Provider Name (Legal Business Name): MS. LISA ANN KEELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 DECANTER CIR
WINDSOR CA
95492-6657
US

IV. Provider business mailing address

205 DECANTER CIR
WINDSOR CA
95492-6657
US

V. Phone/Fax

Practice location:
  • Phone: 940-453-2841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95234109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: