Organization
K ELLIS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEISHA ELLIS (AUTHORIZED OFFICIAL/OWNER)
(904) 252-3606
Entity
Organization
Contact information
Practice address
1209 MOUNTAIN ROAD PL NE # 4953, ALBUQUERQUE, NM 87110-7845
(904) 252-3606
(505) 546-4325
Mailing address
1209 MOUNTAIN ROAD PL NE # 4953, ALBUQUERQUE, NM 87110-7845
(904) 252-3606
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/04/2024
Last updated
09/10/2024
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