Individual
KATHLEEN KETELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4921 E BELL RD STE 205, SCOTTSDALE, AZ 85254-6002
(800) 640-3451
Mailing address
PO BOX 1200, PLEASANT GROVE, UT 84062-1200
(800) 640-3451
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
287380
AZ
363LF0000X
Family Nurse Practitioner
201050158NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201050158NP
STATE LICENSE
OR
05
—
500627501
—
OR
Enumeration date
10/06/2010
Last updated
11/05/2024
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