Healthcare Provider Details

I. General information

NPI: 1750632998
Provider Name (Legal Business Name): CHANDRA LYNN KEELE RN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BRIARWOOD AVE STE 203
MIDLAND TX
79707
US

IV. Provider business mailing address

5309 GREATHOUSE AVE
MIDLAND TX
79707-3133
US

V. Phone/Fax

Practice location:
  • Phone: 432-687-6870
  • Fax: 432-687-5558
Mailing address:
  • Phone: 432-853-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP122520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: