Healthcare Provider Details

I. General information

NPI: 1710829106
Provider Name (Legal Business Name): KELLY DARMODY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 W WASHINGTON ST
WEST BEND WI
53095-2439
US

IV. Provider business mailing address

5818 WILDLIFE DR
ALLENTON WI
53002-9521
US

V. Phone/Fax

Practice location:
  • Phone: 262-421-5135
  • Fax: 414-488-1407
Mailing address:
  • Phone: 262-421-5135
  • Fax: 414-488-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLY DARMODY
Title or Position: OWNER, CEO
Credential: MD
Phone: 262-421-5135