Provider Demographics
NPI:1235688771
Name:BALIGNASAY, KELLY-JO PASS (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY-JO
Middle Name:PASS
Last Name:BALIGNASAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELLY-JO
Other - Middle Name:
Other - Last Name:PASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3108 155TH CIR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-1648
Mailing Address - Country:US
Mailing Address - Phone:515-554-1737
Mailing Address - Fax:
Practice Address - Street 1:450 LAUREL ST STE A
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3045
Practice Address - Country:US
Practice Address - Phone:515-247-8400
Practice Address - Fax:515-248-8888
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-105278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily