Provider Demographics
NPI:1356100721
Name:RATAJCZYK, KEELY BROOKE (FNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:BROOKE
Last Name:RATAJCZYK
Suffix:
Gender:F
Credentials:FNP-BC, FNP-C
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:BROOKE
Other - Last Name:WILBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 CAMINO DEL RIO S STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12300 LAS VEGAS BLVD S
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-9506
Practice Address - Country:US
Practice Address - Phone:702-837-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV876653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily