Provider Demographics
NPI:1588257695
Name:THRELKELD, JOLYN (ARNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:JOLYN
Middle Name:
Last Name:THRELKELD
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:JOLIE
Other - Middle Name:
Other - Last Name:THRELKED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP, FNP-BC
Mailing Address - Street 1:1200 1ST AVE E STE 2
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4331
Mailing Address - Country:US
Mailing Address - Phone:712-264-6550
Mailing Address - Fax:712-264-6553
Practice Address - Street 1:1200 1ST AVE E STE 2
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4331
Practice Address - Country:US
Practice Address - Phone:712-264-6550
Practice Address - Fax:712-264-6553
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA162514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily