Healthcare Provider Details

I. General information

NPI: 1689237059
Provider Name (Legal Business Name): KELSEY ELLEN REDMOND ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 04/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 2ND AVE N
FORT DODGE IA
50501-4119
US

IV. Provider business mailing address

1980 HIGHWAY 1 NE
SOLON IA
52333-9767
US

V. Phone/Fax

Practice location:
  • Phone: 515-574-6110
  • Fax:
Mailing address:
  • Phone: 309-502-9079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA154037
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: