Healthcare Provider Details

I. General information

NPI: 1790608099
Provider Name (Legal Business Name): KEELY FRAZIER CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 LOMAS BLVD NE
ALBUQUERQUE NM
87112-5512
US

IV. Provider business mailing address

11300 LOMAS BLVD NE
ALBUQUERQUE NM
87112-5512
US

V. Phone/Fax

Practice location:
  • Phone: 505-450-4072
  • Fax:
Mailing address:
  • Phone: 505-450-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: