Healthcare Provider Details

I. General information

NPI: 1932146792
Provider Name (Legal Business Name): KATHLEEN NELSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 5TH ST
FONTANELLE IA
50846-8308
US

IV. Provider business mailing address

406 5TH ST
FONTANELLE IA
50846-8308
US

V. Phone/Fax

Practice location:
  • Phone: 641-745-4300
  • Fax: 641-745-2024
Mailing address:
  • Phone: 641-745-4300
  • Fax: 641-745-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA053391
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: