Healthcare Provider Details

I. General information

NPI: 1114350840
Provider Name (Legal Business Name): KELLY JO O'REILLY ALBER ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY JO O'REILLY

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S MAIN ST
MONTICELLO IA
52310-1733
US

IV. Provider business mailing address

1522 220TH ST
MANCHESTER IA
52057-8948
US

V. Phone/Fax

Practice location:
  • Phone: 319-465-5937
  • Fax:
Mailing address:
  • Phone: 563-927-3708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA115009
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: