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NPI Code Detail

MEDICARE: KELLY J JERGENSON ARNP

MEDICARE: KELLY J JERGENSON ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerA-077904IA

General Provider Information

NPI Number : 1114921772
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY J JERGENSON ARNP
Provider Business Mailing Address
First Line : 221 MAIN AVE
Second Line :
City : CLINTON
State : IA
Zip : 52732-2241
Country : US
Telephone Number : 563-242-7522
Fax Number : 563-242-7534
Provider Business Practice Location Address
First Line : 221 MAIN AVE
Second Line :
City : CLINTON
State : IA
Zip : 52732-2241
Country : US
Telephone Number : 563-242-7522
Fax Number : 563-242-7534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 10/05/2007

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