Healthcare Provider Details

I. General information

NPI: 1033641683
Provider Name (Legal Business Name): KEELY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 10/31/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 3RD STREET
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

1201 3RD STREET
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-8231
  • Fax:
Mailing address:
  • Phone: 505-764-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number65341
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: