Provider Demographics
NPI:1699802637
Name:SAHL, KELLY D (NP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:D
Last Name:SAHL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N BEAVER ST
Mailing Address - Street 2:BLDG 6
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3100
Mailing Address - Country:US
Mailing Address - Phone:978-527-4325
Mailing Address - Fax:
Practice Address - Street 1:710 N BEAVER ST
Practice Address - Street 2:BLDG 6
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3100
Practice Address - Country:US
Practice Address - Phone:978-527-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161915363LF0000X
AZAP4428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO015131OtherKAISER COMMERCIAL NUMBER