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General NPI Number Information
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NPI Number | 1699385419
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Entity Type | Individual
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Provider Name | KELSEY RANDALL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 9003 E SHEA BLVD # AZ85260
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6709
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Country | US
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Telephone | 928-607-8345
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Fax |
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Provider Business Mailing Address
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Address Line | 955 E KNOX RD UNIT 230
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City | CHANDLER
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State | AZ
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Zip | 85225-1482
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 243374
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | RN179953
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License Number State | AZ
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