Provider Demographics
NPI:1003197526
Name:DORSEY, KELLI JO (RN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:JO
Last Name:DORSEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 S EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1562
Mailing Address - Country:US
Mailing Address - Phone:641-424-2075
Mailing Address - Fax:641-424-9555
Practice Address - Street 1:235 S EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1562
Practice Address - Country:US
Practice Address - Phone:641-424-2075
Practice Address - Fax:641-424-9555
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse