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General NPI Number Information
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NPI Number | 1043802127
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Entity Type | Organization
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Legal Business Name | KEELEY PSYCHIATRY LLC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 5100 BUCKEYSTOWN PIKE STE 250
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City | FREDERICK
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State | MD
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Zip | 21704-8344
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Country | US
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Telephone | 186-439-9383
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 BUCKEYSTOWN PIKE STE 250
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City | FREDERICK
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State | MD
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Zip | 21704-8344
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Country | US
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Telephone | 186-439-9383
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | PATRICK NIMUBONA
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Credential |
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Telephone | 917-671-9402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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