Healthcare Provider Details

I. General information

NPI: 1902554306
Provider Name (Legal Business Name): KELLY L NEPHEW DNP, FNP-BC, CME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N WEST VIEW DR
OSCEOLA IA
50213-8267
US

IV. Provider business mailing address

PO BOX 3373
ROCK ISLAND IL
61204-3373
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax:
Mailing address:
  • Phone: 563-219-7225
  • Fax: 563-823-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277.003818
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA167920
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: