Healthcare Provider Details

I. General information

NPI: 1740818954
Provider Name (Legal Business Name): KELSIE MARIE HOLMES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSIE MARIE SMITH DO

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/11/2024
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 S MARSHALL STREET
BOONE IA
50036-5304
US

IV. Provider business mailing address

1115 S MARSHALL STREET
BOONE IA
50036-5304
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-2335
  • Fax: 515-432-2357
Mailing address:
  • Phone: 515-432-2335
  • Fax: 515-432-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61435796
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO06796
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: