Active NPI
Kelly Marie Gunderson, PHARMD
- Pharmacist
- Fort Dodge, IA
National Provider Identifier
1659921450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22809
- Practice address
- 3036 1St Ave S
Fort Dodge, IA 50501-2925 - Phone
- (515) 576-7405
- NPI assigned
- Sep 13, 2019
- Last updated
- Aug 25, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 22809 | IA | Primary |
Addresses
Primary practice location
3036 1St Ave S
Fort Dodge, IA 50501-2925
Mailing address
3036 1St Ave S
Fort Dodge, IA 50501-2925
Phone (515) 576-7405
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22809 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724544000000",
"number": "1659921450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3036 1ST AVE S",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "505012925",
"telephone_number": "515-576-7405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3036 1ST AVE S",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "505012925",
"telephone_number": "515-576-7405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSON",
"first_name": "KELLY",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-13",
"last_updated": "2024-08-25",
"certification_date": "2024-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "22809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Dodge, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.