Healthcare Provider Details

I. General information

NPI: 1801786173
Provider Name (Legal Business Name): HANNAH REBECCA KELLY RN, BAN, ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH REBECCA GESING

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E MAIN ST
WAUKON IA
52172-1735
US

IV. Provider business mailing address

1322 315TH AVE
FORT ATKINSON IA
52144-7112
US

V. Phone/Fax

Practice location:
  • Phone: 563-568-5530
  • Fax:
Mailing address:
  • Phone: 563-568-9653
  • Fax: 563-568-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number176661
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA185428
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: