Provider Demographics
NPI:1609463710
Name:KASPER, CRAIG ALAN SR (FNP-C)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALAN
Last Name:KASPER
Suffix:SR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3783 E WOODSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7886
Mailing Address - Country:US
Mailing Address - Phone:760-808-2320
Mailing Address - Fax:949-655-5918
Practice Address - Street 1:5151 E BROADWAY RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1346
Practice Address - Country:US
Practice Address - Phone:480-690-8815
Practice Address - Fax:949-655-5918
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251497363LF0000X
CA95153436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily