Provider Demographics
NPI:1609463710
Name:KASPER, CRAIG ALAN SR (FNP-C)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALAN
Last Name:KASPER
Suffix:SR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15180 W CAPRICORN DR
Mailing Address - Street 2:
Mailing Address - City:ELOY
Mailing Address - State:AZ
Mailing Address - Zip Code:85131-3399
Mailing Address - Country:US
Mailing Address - Phone:760-808-2320
Mailing Address - Fax:
Practice Address - Street 1:4834 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3610
Practice Address - Country:US
Practice Address - Phone:602-804-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95153436363LF0000X
AZ251497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily