Provider Demographics
NPI:1659764124
Name:KELCH, KALAN ANN (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:KALAN
Middle Name:ANN
Last Name:KELCH
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 W MCDOWELL RD STE A104
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2518
Mailing Address - Country:US
Mailing Address - Phone:480-561-5000
Mailing Address - Fax:480-984-4066
Practice Address - Street 1:14445 W MCDOWELL RD STE A104
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2518
Practice Address - Country:US
Practice Address - Phone:480-561-5000
Practice Address - Fax:480-984-4066
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ221426363LG0600X, 363LA2100X
FL9400933363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology