Provider Demographics
NPI:1124709829
Name:KELLEHER, KASSIANI ALEXANDRA (DNP, ARNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:KASSIANI
Middle Name:ALEXANDRA
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:DNP, ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 KOUDSI BLVD NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-7025
Mailing Address - Country:US
Mailing Address - Phone:319-491-6026
Mailing Address - Fax:
Practice Address - Street 1:1340 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1900
Practice Address - Country:US
Practice Address - Phone:319-398-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG176589363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health