Individual
KEELY DYLAN WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
601 DR MARTIN LUTHER KING JR AVE NE, ALBUQUERQUE, NM 87102-3619
(505) 727-8206
Mailing address
4101 INDIAN SCHOOL RD NE STE 110, ALBUQUERQUE, NM 87110-3991
Taxonomy
Speciality
Code
Description
License number
State
163WF0300X
Flight Registered Nurse
R67438
NM
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
CNP-03497
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14884739
—
NM
Enumeration date
05/14/2013
Last updated
03/07/2018
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