Healthcare Provider Details

I. General information

NPI: 1356729453
Provider Name (Legal Business Name): ADAM D. KELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

IV. Provider business mailing address

104 WENTWORTH DR
ENTERPRISE AL
36330-4152
US

V. Phone/Fax

Practice location:
  • Phone: 332-249-1116
  • Fax:
Mailing address:
  • Phone: 859-779-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-02974
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: