Healthcare Provider Details

I. General information

NPI: 1538597000
Provider Name (Legal Business Name): KELLIE LINNE JARZEMBAK APRN,ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLIE LINNE BELEW

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 PARK EAST DR STE 450
BEACHWOOD OH
44122-4318
US

IV. Provider business mailing address

PO BOX 211699
EAGAN MN
55121-3699
US

V. Phone/Fax

Practice location:
  • Phone: 668-490-6928
  • Fax: 888-973-8821
Mailing address:
  • Phone: 866-849-0692
  • Fax: 888-973-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15289
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027334
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3-002715
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0104342-C-NP
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number322153
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11020801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: