Provider Demographics
NPI:1730898891
Name:KEETH, AMARIS (RN)
Entity type:Individual
Prefix:
First Name:AMARIS
Middle Name:
Last Name:KEETH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMARIS
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NM
Mailing Address - Zip Code:88415-0134
Mailing Address - Country:US
Mailing Address - Phone:806-626-5258
Mailing Address - Fax:
Practice Address - Street 1:323 S 5TH ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NM
Practice Address - Zip Code:88415-2641
Practice Address - Country:US
Practice Address - Phone:806-626-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56188163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool