Provider Demographics
NPI:1669222865
Name:DE VILLIERS, KELSEY LYNN (FNP - C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:DE VILLIERS
Suffix:
Gender:F
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 1:2633 E ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2429
Mailing Address - Country:US
Mailing Address - Phone:480-818-3150
Mailing Address - Fax:
Practice Address - Street 1:3540 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-9627
Practice Address - Country:US
Practice Address - Phone:623-267-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ305140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily