Provider Demographics
NPI:1528725033
Name:DOBBS, KEELY
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:
Last Name:DOBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 HARPER DR NE STE 410
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3585
Mailing Address - Country:US
Mailing Address - Phone:505-843-7813
Mailing Address - Fax:505-843-6947
Practice Address - Street 1:5700 HARPER DR NE STE 410
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3585
Practice Address - Country:US
Practice Address - Phone:505-843-7813
Practice Address - Fax:505-843-6947
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NMPA2021-0109363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant