Healthcare Provider Details

I. General information

NPI: 1235133729
Provider Name (Legal Business Name): KELLY ANN WOODS CPNP/FPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ANN GEISER

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 2ND ST S
SARTELL MN
56377-1917
US

IV. Provider business mailing address

111 2ND ST S
SARTELL MN
56377-1917
US

V. Phone/Fax

Practice location:
  • Phone: 320-281-3339
  • Fax: 952-927-8610
Mailing address:
  • Phone: 320-281-3339
  • Fax: 320-200-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1651940
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR165194-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: