Kelly Upson, DNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

A164619 Issued in IA

Practice address

1750 W Broadway
Council Bluffs, IA 51501-3814

Phone

(712) 215-6588

Fax

(712) 322-9585

NPI assigned

Aug 17, 2021

Sex

Female

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)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• CRC Recovery, Inc.

  dba Council Bluffs Comprehensive Treatment Center

  • Methadone Clinic
  • Council Bluffs, IA
  • NPI 1326689076
  NPD

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1861168296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013814",
            "telephone_number": "712-215-6588",
            "fax_number": "712-322-9585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013814",
            "telephone_number": "712-215-6588",
            "fax_number": "712-322-9585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7500 Mercy Rd",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681242319",
            "country_code": "US",
            "telephone_number": "402-398-6060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UPSON",
        "first_name": "KELLY",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-17",
        "last_updated": "2023-03-15",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A164619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delores Jean Tye, OPTICIAN
• Nadia Lynn Tymkowych, M.D.
• Aster Tyrie
• Michael Brian Uhrlaub, MPT
• Rosemary Ulmer
• Ailen Estrelles Urso
• Noah Urwiler, DPT
• Connie Utley
• Joyce Vacek, PAC
• Candice Stark Vallejo, LISW

• Nurse Practitioner in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; 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.