Provider Demographics
NPI:1902554306
Name:NEPHEW, KELLY L (DNP, FNP-BC, CME)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:NEPHEW
Suffix:
Gender:F
Credentials:DNP, FNP-BC, CME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3373
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61204-3373
Mailing Address - Country:US
Mailing Address - Phone:563-219-7225
Mailing Address - Fax:563-823-6665
Practice Address - Street 1:444 N WEST VIEW DR
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-8267
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA167920363LF0000X
IL277.003818363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF02221107OtherAANP