Provider Demographics
NPI:1346901451
Name:BRASFIELD, KEITH ERIC (PMHNP)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ERIC
Last Name:BRASFIELD
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 S 162ND ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-8466
Mailing Address - Country:US
Mailing Address - Phone:480-388-5818
Mailing Address - Fax:
Practice Address - Street 1:4940 S 162ND ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-8466
Practice Address - Country:US
Practice Address - Phone:480-388-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ268457363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health