Healthcare Provider Details

I. General information

NPI: 1275863979
Provider Name (Legal Business Name): KELSEY L NANK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 FRANKLIN ST
KEOSAUQUA IA
52565-1164
US

IV. Provider business mailing address

304 FRANKLIN ST
KEOSAUQUA IA
52565-1164
US

V. Phone/Fax

Practice location:
  • Phone: 319-293-3171
  • Fax:
Mailing address:
  • Phone: 319-293-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002047
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: