Individual
KELSEY RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
9003 E SHEA BLVD # AZ85260, SCOTTSDALE, AZ 85260-6709
(928) 607-8345
Mailing address
955 E KNOX RD UNIT 230, CHANDLER, AZ 85225-1482
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
RN179953
AZ
363LF0000X
Family Nurse Practitioner
Primary
243374
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22467622
NATIONAL COUNCIL OF STATE BOARDS OF NURSING
AZ
01
—
243374
CERTIFIED NURSE PRACTITIONER LICENSE NUMBER
AZ
Enumeration date
08/06/2020
Last updated
08/14/2020
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