Provider Demographics
NPI:1376125088
Name:MAHONEY, KELSEY TROY (ARNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:TROY
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:TROY
Other - Last Name:MCKEAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2237
Mailing Address - Fax:319-384-5547
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2237
Practice Address - Fax:319-384-5547
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC160926363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics