Healthcare Provider Details

I. General information

NPI: 1124554084
Provider Name (Legal Business Name): KELLI ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WESTRIDGE RD
CARLSBAD NM
88220-3550
US

IV. Provider business mailing address

PO BOX 3141
CARLSBAD NM
88221-3141
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5552
  • Fax: 575-725-5552
Mailing address:
  • Phone: 575-725-5552
  • Fax: 575-725-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: