Healthcare Provider Details

I. General information

NPI: 1447179221
Provider Name (Legal Business Name): KEENEN RASHAD WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4504
US

IV. Provider business mailing address

30 SOUTHWIND DR
ALAMOGORDO NM
88310-9035
US

V. Phone/Fax

Practice location:
  • Phone: 502-409-6993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number1003458357
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: