Individual provider Active NPI

Kelsey Brooke Johnson, ARNP

  • Family Nurse Practitioner
  • Red Oak, IA
National Provider Identifier
1992591002
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A183921 Issued in IA
Practice address
1400 Senate Ave Ste 108
Red Oak, IA 51566-1271
Phone
(712) 623-7000
NPI assigned
Apr 16, 2025
Last updated
Apr 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A183921 IA Primary

Addresses

Primary practice location

1400 Senate Ave Ste 108
Red Oak, IA 51566-1271

Mailing address

1400 Senate Ave Ste 108
Red Oak, IA 51566-1271
Phone (712) 623-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250625002741 IA Practitioner - Nurse Practitioner 4688186539 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Montgomery County Memorial HospitalGroup PAC ID 9032015805, shared by 7 NPIs, 43 clinicians

Practice addresses (Care Compare)

1400 Senate Ave
102 Women's Health Clinic
Red Oak, IA 51566-1271
Phone (712) 623-6335

202 Central Ave
Villisca, IA 50864-1025
Phone (712) 826-9592

415 Main St
Suite 1
Malvern, IA 51551-8137
Phone (712) 624-6010

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A183921IAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montgomery County Memorial Hospital Family CurrentSince May 5, 2025 Accepting new patients
Montgomery County Memorial Hospital Current Accepting new patients
Montgomery County Memorial Hospital CurrentSince May 5, 2025 Accepting new patients

Locations

1400 Senate Ave
Ste 103
Red Oak, IA 51566
Phone (712) 623-7240

1400 Senate Ave
Ste 108
Red Oak, IA 51566
Phone (712) 623-5101

1400 Senate Ave
Ste 108103
Red Oak, IA 51566
Phone (712) 623-7280

2301 Eastern Ave
Red Oak, IA 51566
Phone (712) 623-7270

205 N U Ave
Villisca, IA 50864
Phone (712) 826-4422

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1744761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1992591002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SENATE AVE STE 108",
            "city": "RED OAK",
            "state": "IA",
            "postal_code": "515661271",
            "telephone_number": "712-623-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SENATE AVE STE 108",
            "city": "RED OAK",
            "state": "IA",
            "postal_code": "515661271",
            "telephone_number": "712-623-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELSEY",
        "middle_name": "BROOKE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-16",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A183921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Oak, IA

Sources for this page

Verify at the official NPI Registry.