Healthcare Provider Details

I. General information

NPI: 1790615565
Provider Name (Legal Business Name): CASEY KIEFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 548
SELLS AZ
85634-0548
US

IV. Provider business mailing address

PO BOX 548
SELLS AZ
85634-0548
US

V. Phone/Fax

Practice location:
  • Phone: 520-383-7200
  • Fax:
Mailing address:
  • Phone: 520-383-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: