Basic Information
| Provider Information | |||||||||
| NPI: | 1639343742 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELCH | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1719 N DYSART RD | ||||||||
| Address2: | |||||||||
| City: | AVONDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853921213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024396784 | ||||||||
| FaxNumber: | 6023714960 | ||||||||
| Practice Location | |||||||||
| Address1: | 6818 W THUNDERBIRD RD | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853815025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235663550 | ||||||||
| FaxNumber: | 6235663573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2008 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN13358 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | ARNP9319197 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | AP4061 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.