Healthcare Provider Details

I. General information

NPI: 1801992532
Provider Name (Legal Business Name): KELLY MARIE RAGALLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 FUTURES DR
SOUTH SIOUX CITY NE
68776-3917
US

IV. Provider business mailing address

1021 NEBRASKA ST
SIOUX CITY IA
51105-1436
US

V. Phone/Fax

Practice location:
  • Phone: 712-252-2477
  • Fax: 712-252-5920
Mailing address:
  • Phone: 712-252-2477
  • Fax: 712-252-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA-105358
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110826
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: