Healthcare Provider Details

I. General information

NPI: 1871168153
Provider Name (Legal Business Name): WILLIAM KELAN NESBITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

3812 127TH ST
LUBBOCK TX
79423-1319
US

V. Phone/Fax

Practice location:
  • Phone: 806-775-8200
  • Fax:
Mailing address:
  • Phone: 469-328-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberV9675
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: