Healthcare Provider Details

I. General information

NPI: 1104455328
Provider Name (Legal Business Name): RACHEL KELLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAGEBRUSH ST SW
ALBUQUERQUE NM
87105-3942
US

IV. Provider business mailing address

1 SAGEBRUSH ST SW
ALBUQUERQUE NM
87105-3942
US

V. Phone/Fax

Practice location:
  • Phone: 505-869-3200
  • Fax: 505-869-4088
Mailing address:
  • Phone: 505-869-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2023-1365
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: