Healthcare Provider Details

I. General information

NPI: 1235688771
Provider Name (Legal Business Name): KELLY-JO PASS BALIGNASAY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY-JO PASS

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6165 NW 86TH ST
JOHNSTON IA
50131-2240
US

IV. Provider business mailing address

3108 155TH CIR
URBANDALE IA
50323-1648
US

V. Phone/Fax

Practice location:
  • Phone: 515-512-9161
  • Fax: 515-293-6931
Mailing address:
  • Phone: 515-554-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-105278
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: