Provider Demographics
NPI:1427764661
Name:LANGE, KELSEY LYNN (NP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:LANGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 281ST AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:IA
Mailing Address - Zip Code:52037-9189
Mailing Address - Country:US
Mailing Address - Phone:563-219-5528
Mailing Address - Fax:
Practice Address - Street 1:2705 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3008
Practice Address - Country:US
Practice Address - Phone:563-900-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA172884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily