Provider Demographics
NPI:1700366101
Name:SCHEFFERT, KELLY (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SCHEFFERT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-3155
Mailing Address - Country:US
Mailing Address - Phone:319-332-0999
Mailing Address - Fax:
Practice Address - Street 1:1600 1ST ST E
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-3155
Practice Address - Country:US
Practice Address - Phone:319-332-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG121629363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health