Robert Anthony Kiesecker Jr., DNP, FNP-BC

Primary specialty

Occupational Health Nurse PractitionerTaxonomy code 363LX0106X

License

201909324NP-PP Issued in OR

Practice address

781 Black Oak Dr Ste 102
Medford, OR 97504-9501

Phone

(541) 789-4236

Fax

(541) 789-5965

NPI assigned

Jan 16, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 6

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: robert.kiesecker.p4@direct.caremorewest.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  NPD
• Carelon Medical Partners of Arizona, P.C.

  • Family Medicine Physician
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  • NPI 1972879773
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1750567129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "928-759-5987",
            "fax_number": "928-458-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 BLACK OAK DR STE 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049501",
            "telephone_number": "541-789-4236",
            "fax_number": "541-789-5965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIESECKER",
        "first_name": "ROBERT",
        "middle_name": "ANTHONY",
        "name_suffix": "Jr.",
        "credential": "DNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-16",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP2889",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60681430",
            "primary": false
        },
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "OR",
            "license": "201909324NP-PP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405773",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750567129",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z197493",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OR NP LICENSE",
            "identifier": "201909324NP-PP",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ LICENSE",
            "identifier": "AP2889",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE WVH",
            "identifier": "P01708343",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "robert.kiesecker@asante.org",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "781 Black Oak Dr Ste 102",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975049501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vinshi Khan, M.D.
• Tariq Khreis, MD
• Michael Kidd, OTR/L
• Kids Clinic
• Stacey Kiefer, B.S.
• Billy Emily Grace Kile
• Eileen M Killackey-Bobek, MD
• Andrew D Kim, MD
• Angela Kim
• Hidong Kim, MD, PHD

• Occupational Health Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Occupational Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.