Healthcare Provider Details

I. General information

NPI: 1740381243
Provider Name (Legal Business Name): KELLER WELLS AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 W LAKE MEAD PKWY STE 19
HENDERSON NV
89015-7055
US

IV. Provider business mailing address

PO BOX 530124
HENDERSON NV
89053-0124
US

V. Phone/Fax

Practice location:
  • Phone: 702-568-6108
  • Fax: 702-568-8603
Mailing address:
  • Phone: 702-568-6108
  • Fax: 702-568-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ORLANDIS L WELLS
Title or Position: PRESIDENT
Credential: MD
Phone: 702-568-6108