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General NPI Number Information
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NPI Number | 1891347464
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Entity Type | Individual
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Provider Name | KELLI ANN BURESH DNP ARNP AGPCNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 55 CENTRAL IOWA DR
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City | MARSHALLTOWN
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State | IA
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Zip | 50158-4705
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Country | US
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Telephone | 641-754-8039
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Fax |
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Provider Business Mailing Address
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Address Line | 510 BRENTWOOD PL
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City | MARSHALLTOWN
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State | IA
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Zip | 50158-3720
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Country | US
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Telephone | 641-751-8039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | HI55243
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | H155243
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | HI55243
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License Number State | IA
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