Provider Demographics
NPI:1427586197
Name:STREETER, KELSY DEVAN (DNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:KELSY
Middle Name:DEVAN
Last Name:STREETER
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7900
Mailing Address - Fax:
Practice Address - Street 1:70 N MCCLINTOCK DR STE 4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3711
Practice Address - Country:US
Practice Address - Phone:855-501-1004
Practice Address - Fax:480-464-2338
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10155363LP0808X
CANP95023089363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health