Provider Demographics
NPI:1710522024
Name:RESLER, KELSEY (NP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RESLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 29650
Mailing Address - Street 2:DEPT# 880392
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038
Mailing Address - Country:US
Mailing Address - Phone:480-616-0676
Mailing Address - Fax:602-742-0315
Practice Address - Street 1:4915 E BASELINE RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2966
Practice Address - Country:US
Practice Address - Phone:480-616-0676
Practice Address - Fax:602-742-0315
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227499363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health