Provider Demographics
NPI:1821468927
Name:DAWLEY, KELLEY MICHELLE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:MICHELLE
Last Name:DAWLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:KELLEY
Other - Middle Name:MICHELLE
Other - Last Name:SAHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1225 S GEAR AVE STE 153
Mailing Address - Street 2:
Mailing Address - City:W BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1686
Mailing Address - Country:US
Mailing Address - Phone:319-754-4400
Mailing Address - Fax:319-754-4412
Practice Address - Street 1:1225 S GEAR AVE STE 153
Practice Address - Street 2:
Practice Address - City:W BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1686
Practice Address - Country:US
Practice Address - Phone:319-754-4400
Practice Address - Fax:319-754-4412
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH132226363L00000X
IL209.014102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1821468927Medicaid
IA1821468927Medicaid
IAI54810007Medicare UPIN