ROBERT ANTHONY KIESECKER JR. (NPI# 1750567129) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1750567129 |
Entity Type | Individual |
Full Name | ROBERT ANTHONY KIESECKER JR. |
Credential | DNP, FNP-BC |
Practice Address |
781 Black Oak Dr Ste 102 Medford OR 97504-9501 |
Mailing Address |
Po Box 10880 Prescott AZ 86304-0880 |
Practice Telephone | 5417894236 |
Practice Fax Number | 5417895965 |
Mailing Telephone | 9287595987 |
Mailing Fax Number | 9284582039 |
Enumeration Date | 2008-01-16 |
Last Update Date | 2020-02-26 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP2889 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
N | 363L00000X | Nurse Practitioner | AP60681430 | WA | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363LX0106X |
Nurse Practitioner Specialization: Occupational Health |
201909324NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
OR | OR NP LICENSE | 201909324NP-PP | 01 |
AZ | MEDICARE | Z197493 | 01 |
WA | 1750567129 | 05 | |
AZ | AZ LICENSE | AP2889 | 01 |
AZ | 405773 | 05 | |
WA | RR MEDICARE WVH | P01708343 | 01 |
Address | Telephone Number | Fax Number |
---|---|---|
820 N Chelan Ave, Wenatchee, WA 988012028 | 5096638711 |
Street Address |
781 BLACK OAK DR STE 102 |
City | MEDFORD |
State | OR |
Zip Code | 97504-9501 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619324209 | Michael Kidd | Occupational Therapist | 781 Black Oak Dr Ste 102, Medford, OR 97504-9501 | 2016-05-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
Find all providers in zip 97504 |
Taxonomy Code | 363LX0106X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Occupational Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649305764 | Helen Josey | Nurse Practitioner | 781 Black Oak Dr, Suite 102, Medford, OR 97504-9502 | 2007-02-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114144193 | James D Barger | Nurse Practitioner | 9290 Se Sunnybrook Blvd, Suite 210, Clackamas, OR 97015-6899 | 2007-04-19 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.