Provider Demographics
NPI:1477504124
Name:KELCHEN, SHERRY LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:KELCHEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LYNN
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1500 ASSOCIATES DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2201
Mailing Address - Country:US
Mailing Address - Phone:563-584-4100
Mailing Address - Fax:563-584-4110
Practice Address - Street 1:805 JOHNSON ST SW
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:IA
Practice Address - Zip Code:52033-8636
Practice Address - Country:US
Practice Address - Phone:563-852-7756
Practice Address - Fax:563-852-7759
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099508363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P46594Medicare UPIN
I8603Medicare ID - Type Unspecified