Carrie Anne Kelderman, BSN, RN

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

L-22096 Issued in IA

Practice address

404 Jefferson St
Pella, IA 50219-1257

Phone

(641) 628-6613

NPI assigned

Sep 9, 2020

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1962017764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 JEFFERSON ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191257",
            "telephone_number": "641-628-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 JEFFERSON ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191257",
            "telephone_number": "641-628-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELDERMAN",
        "first_name": "CARRIE",
        "middle_name": "ANNE",
        "credential": "BSN, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-09",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "IA",
            "license": "L-22096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA NURSING LICENSE",
            "identifier": "L-22096",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mindi Jo Jorgenson, PHARMD
• K D Enterprises Co Inc
• Stewart Douglas Kanis, DO
• Alicia Mae Kautzman, PHYSICAL THERAPIST
• Deborah Emily Kay-Ostrander, MS,IAADC
• Michelle Kellar, LMHC
• Cara Shannon Kelley, NCC, LMHC
• Christina Noel Kelley, PA
• Kenneth W Van Wyk
• Timothy E Kinkade, CRNA

• All providers in Pella, IA
• Lactation Consultant (Registered Nurse) in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; 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.