Healthcare Provider Details

I. General information

NPI: 1104320944
Provider Name (Legal Business Name): HOLLY KEELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 SHOAL CREEK BLVD STE 100
AUSTIN TX
78757-7589
US

IV. Provider business mailing address

4512 AVENUE F
AUSTIN TX
78751-3109
US

V. Phone/Fax

Practice location:
  • Phone: 512-494-4000
  • Fax:
Mailing address:
  • Phone: 715-412-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberU4835
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU4835
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: