Edward Lawrence Kelly Jr., LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

P12593 Issued in IA

Practice address

711 S Vine St
Glenwood, IA 51534-1927

Phone

(712) 525-1344

NPI assigned

Jan 15, 2008

Last updated

Jan 15, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200355200000",
    "number": "1083890503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 WASHINGTON AVE",
            "city": "RED OAK",
            "state": "IA",
            "postal_code": "515662439",
            "telephone_number": "712-623-6862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 S VINE ST",
            "city": "GLENWOOD",
            "state": "IA",
            "postal_code": "515341927",
            "telephone_number": "712-525-1344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "EDWARD",
        "middle_name": "LAWRENCE",
        "name_suffix": "Jr.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-15",
        "last_updated": "2008-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IA",
            "license": "P12593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Glenwood, IA
• Providers in Glenwood, IA by specialty
• Licensed Practical Nurse in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.