Healthcare Provider Details

I. General information

NPI: 1245983857
Provider Name (Legal Business Name): KELLIE MARIE KAESCHE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W CHANDLER HEIGHTS RD
CHANDLER AZ
85248-5055
US

IV. Provider business mailing address

28755 N GOLD LN
SAN TAN VALLEY AZ
85143-5699
US

V. Phone/Fax

Practice location:
  • Phone: 480-716-4107
  • Fax:
Mailing address:
  • Phone: 775-800-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number233980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: