Provider Demographics
NPI:1568660785
Name:HAUK, KEELIE NICOLE (RDH)
Entity Type:Individual
Prefix:
First Name:KEELIE
Middle Name:NICOLE
Last Name:HAUK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-6737
Mailing Address - Country:US
Mailing Address - Phone:806-293-8561
Mailing Address - Fax:806-293-8413
Practice Address - Street 1:850 MARTIN ROAD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107
Practice Address - Country:US
Practice Address - Phone:806-374-7341
Practice Address - Fax:806-374-0316
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14327124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist