Provider Demographics
NPI:1891187340
Name:KELSCH, BRENT (NP-C)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:KELSCH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21321 E OCOTILLO RD STE 133
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5995
Mailing Address - Country:US
Mailing Address - Phone:480-987-5525
Mailing Address - Fax:480-987-5115
Practice Address - Street 1:21321 E OCOTILLO RD STE 133
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5995
Practice Address - Country:US
Practice Address - Phone:480-987-5525
Practice Address - Fax:480-987-5115
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily