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Individual
ROBERT ANTHONY KIESECKER JR.
Active
Individual
ROBERT ANTHONY KIESECKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, FNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP2889
AZ
363L00000X
Nurse Practitioner
AP60681430
WA
363LX0106X
Occupational Health Nurse Practitioner
Primary
201909324NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750567129
—
WA
01
—
201909324NP-PP
OR NP LICENSE
OR
05
—
405773
—
AZ
01
—
AP2889
AZ LICENSE
AZ
01
—
P01708343
RR MEDICARE WVH
WA
01
—
Z197493
MEDICARE
AZ
Enumeration date
01/16/2008
Last updated
02/26/2020
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