Healthcare Provider Details

I. General information

NPI: 1275902504
Provider Name (Legal Business Name): KATHERINE A. KEELEY, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 WIGWAM PKWY STE 102
HENDERSON NV
89074-7310
US

IV. Provider business mailing address

2649 WIGWAM PKWY STE 102
HENDERSON NV
89074-7310
US

V. Phone/Fax

Practice location:
  • Phone: 702-263-9339
  • Fax: 702-263-8556
Mailing address:
  • Phone: 702-263-9339
  • Fax: 702-263-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE A. KEELEY
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 702-263-9339