Healthcare Provider Details

I. General information

NPI: 1366286015
Provider Name (Legal Business Name): KELSEY DIANE SCHMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 ENTERPRISE AVE
SPIRIT LAKE IA
51360-1073
US

IV. Provider business mailing address

2220 30TH ST
SPIRIT LAKE IA
51360-7576
US

V. Phone/Fax

Practice location:
  • Phone: 712-336-2728
  • Fax:
Mailing address:
  • Phone: 605-354-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA181218
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number161162
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: