Healthcare Provider Details

I. General information

NPI: 1538633151
Provider Name (Legal Business Name): NADIA AMBER KEYS LVN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6313 RICHMOND DR
ROWLETT TX
75089-3911
US

IV. Provider business mailing address

6313 RICHMOND DR
ROWLETT TX
75089-3911
US

V. Phone/Fax

Practice location:
  • Phone: 214-693-1130
  • Fax:
Mailing address:
  • Phone: 214-693-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number322415
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-108392
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: