Provider Demographics
NPI:1932146792
Name:NELSON, KATHLEEN (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FONTANELLE
Mailing Address - State:IA
Mailing Address - Zip Code:50846-8308
Mailing Address - Country:US
Mailing Address - Phone:641-745-4300
Mailing Address - Fax:641-745-2024
Practice Address - Street 1:406 5TH ST
Practice Address - Street 2:
Practice Address - City:FONTANELLE
Practice Address - State:IA
Practice Address - Zip Code:50846-8308
Practice Address - Country:US
Practice Address - Phone:641-745-4300
Practice Address - Fax:641-745-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA053391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3288530Medicaid
IA34499OtherBLUE CROSS/BLUE SHIELD
IA34499OtherBLUE CROSS/BLUE SHIELD
IA3288530Medicaid