Provider Demographics
NPI:1386228153
Name:KIESER, REYNALDO (DNP, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:
Last Name:KIESER
Suffix:
Gender:M
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:REYNALDO
Other - Middle Name:ALVAREZ
Other - Last Name:RODRIGUEZ
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4939 N 43RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2443
Practice Address - Country:US
Practice Address - Phone:602-249-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN201281163WE0003X
AZ259426363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily