Healthcare Provider Details

I. General information

NPI: 1972078988
Provider Name (Legal Business Name): WADE AARON KEETER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 QUAIL CREEK DR
AMARILLO TX
79124-1608
US

IV. Provider business mailing address

705 QUAIL CREEK DR
AMARILLO TX
79124-1608
US

V. Phone/Fax

Practice location:
  • Phone: 806-353-6400
  • Fax:
Mailing address:
  • Phone: 806-353-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139028
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: