Provider Demographics
NPI:1992591002
Name:JOHNSON, KELSEY BROOKE (ARNP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:BROOKE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SENATE AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-1271
Mailing Address - Country:US
Mailing Address - Phone:712-623-7000
Mailing Address - Fax:
Practice Address - Street 1:1400 SENATE AVE STE 108
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1271
Practice Address - Country:US
Practice Address - Phone:712-623-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA183921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily