Healthcare Provider Details

I. General information

NPI: 1013879881
Provider Name (Legal Business Name): KELSEY JANE FRITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13448 N 18TH DR
PHOENIX AZ
85029-1638
US

IV. Provider business mailing address

13448 N 18TH DR
PHOENIX AZ
85029-1638
US

V. Phone/Fax

Practice location:
  • Phone: 530-723-2659
  • Fax:
Mailing address:
  • Phone: 530-723-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1154131
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: