Healthcare Provider Details

I. General information

NPI: 1679434773
Provider Name (Legal Business Name): KAYLA MARIE KELSEN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 E JAVELINA AVE
MESA AZ
85210-6205
US

IV. Provider business mailing address

3440 E SOUTHERN AVE UNIT 1203
MESA AZ
85204-5665
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-3180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number259277
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: