Provider Demographics
NPI:1922989359
Name:KEELY, JESSICA D
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:KEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 RIVER CENTER CT NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7549
Mailing Address - Country:US
Mailing Address - Phone:319-200-5900
Mailing Address - Fax:319-200-5919
Practice Address - Street 1:4251 RIVER CENTER CT NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7549
Practice Address - Country:US
Practice Address - Phone:319-200-5900
Practice Address - Fax:319-200-5919
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA186906363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily