Mary Nan Kelsey IV, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4675 Issued in NE

Practice address

220 N 89TH St
Omaha, NE 68114-4072

Phone

(402) 390-6006

Fax

(402) 390-6446

NPI assigned

Oct 25, 2005

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

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446076800000",
    "number": "1962492678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N 89TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144072",
            "telephone_number": "402-390-6006",
            "fax_number": "402-390-6446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N 89TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144072",
            "telephone_number": "402-390-6006",
            "fax_number": "402-390-6446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELSEY",
        "first_name": "MARY",
        "middle_name": "NAN",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-25",
        "last_updated": "2015-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "4675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toni R Kelly
• Stephanie Leeann Kelnhofer
• Kelsey Periodontal Group, LLC
• Kelsey Raymond LLC
• Cindy Sue Kelsey, RN
• Matthew Ryan Kelsey, D.D.S., M.S.
• Sara Jeannette Kelsey, RD, LMNT
• Tiffani L Kelsey
• William Patrick Kelsey V
• William Patrick Kelsey III, D.D.S.

• General Practice Dentistry in Omaha, NE
• Providers in Omaha, NE by specialty
• General Practice Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.