Provider Demographics
NPI:1376320150
Name:KEITH, KAYLEE MARLENE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MARLENE
Last Name:KEITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S SHILOH RD STE 333
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-8235
Mailing Address - Country:US
Mailing Address - Phone:972-864-2050
Mailing Address - Fax:972-271-3437
Practice Address - Street 1:1919 S SHILOH RD STE 333
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-8235
Practice Address - Country:US
Practice Address - Phone:972-864-2050
Practice Address - Fax:972-271-3437
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily