Healthcare Provider Details

I. General information

NPI: 1790621134
Provider Name (Legal Business Name): KELSIE SCHIEFELBEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18048 W VIA DEL SOL
SURPRISE AZ
85387-2206
US

IV. Provider business mailing address

18048 W VIA DEL SOL
SURPRISE AZ
85387-2206
US

V. Phone/Fax

Practice location:
  • Phone: 602-377-8997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number819481
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: