Provider Demographics
NPI:1114568870
Name:LEOPARD, KELCEY DIANE (FNP-C CST CNOR RNFA)
Entity Type:Individual
Prefix:
First Name:KELCEY
Middle Name:DIANE
Last Name:LEOPARD
Suffix:
Gender:F
Credentials:FNP-C CST CNOR RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N BUTLER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-1323
Mailing Address - Country:US
Mailing Address - Phone:641-203-3251
Mailing Address - Fax:
Practice Address - Street 1:417 S EAST ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1835
Practice Address - Country:US
Practice Address - Phone:641-872-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA168677363L00000X
IA140534163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CEP11471OtherNATIONAL INSTITUTE OF FIRST ASSISTING