Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 673045 | TX |
NPI | 1033133988 |
---|---|
Provider Name | Clay Alan Keller |
First Address | Houston, TX 77075-4874 |
Second Address | Houston, TX 77075-4874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 03/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163001402 | (05) | TX |
Q02070 | (02) | TX |