Provider Demographics
NPI:1508583824
Name:HESKETT, KELI RENEE (RN, CEN)
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:RENEE
Last Name:HESKETT
Suffix:
Gender:F
Credentials:RN, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 ROE DEER CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5222
Mailing Address - Country:US
Mailing Address - Phone:928-951-2055
Mailing Address - Fax:575-339-0915
Practice Address - Street 1:137 ROE DEER CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-5222
Practice Address - Country:US
Practice Address - Phone:928-951-2055
Practice Address - Fax:575-339-0915
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN166995163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty