Healthcare Provider Details

I. General information

NPI: 1003384181
Provider Name (Legal Business Name): PATRICIA KEELER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

# 50 COUNTY RD. 13
CUBA NM
87013
US

IV. Provider business mailing address

PO BOX 70
CUBA NM
87013-0070
US

V. Phone/Fax

Practice location:
  • Phone: 575-289-3211
  • Fax: 575-289-0437
Mailing address:
  • Phone: 575-289-3211
  • Fax: 575-289-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: