Healthcare Provider Details

I. General information

NPI: 1265315782
Provider Name (Legal Business Name): RESIDENTIAL PRESCRIPTIVE SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 S 162ND ST
GILBERT AZ
85298-8466
US

IV. Provider business mailing address

2942 N 24TH ST STE 115 PMB 874450
PHOENIX AZ
85016-7849
US

V. Phone/Fax

Practice location:
  • Phone: 480-388-5818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEITH BRASFIELD
Title or Position: OWNER
Credential:
Phone: 480-388-5818