ROBERT ANTHONY KIESECKER JR.


Address: 781 Black Oak Dr Ste 102, Medford, OR 97504-9501
Phone: 5417894236

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

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

Provider Secondary Practice Location

Address Telephone Number Fax Number
820 N Chelan Ave, Wenatchee, WA 988012028 5096638711

Office Location

Street Address 781 BLACK OAK DR STE 102
City MEDFORD
State OR
Zip Code 97504-9501

Providers in the same location

NPI Name Taxonomy Address Enumeration
1619324209 Michael Kidd Occupational Therapist 781 Black Oak Dr Ste 102, Medford, OR 97504-9501 2016-05-24

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363LX0106X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Occupational Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1649305764 Helen Josey Nurse Practitioner 781 Black Oak Dr, Suite 102, Medford, OR 97504-9502 2007-02-21

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1114144193 James D Barger Nurse Practitioner 9290 Se Sunnybrook Blvd, Suite 210, Clackamas, OR 97015-6899 2007-04-19

Competitor

Search similar providers

City MEDFORD
Zip Code 97504

Improve Information

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Dataset Information

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.

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