Provider Demographics
NPI:1689045148
Name:PFUNDHELLER, KELLY JO (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:PFUNDHELLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-222-7474
Mailing Address - Fax:515-222-7491
Practice Address - Street 1:1601 NW 114TH ST STE 151
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7046
Practice Address - Country:US
Practice Address - Phone:515-222-7474
Practice Address - Fax:515-222-7491
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAA126330363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner