Provider Demographics
NPI:1538597000
Name:JARZEMBAK, KELLIE LINNE (APRN,ACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:LINNE
Last Name:JARZEMBAK
Suffix:
Gender:F
Credentials:APRN,ACNP-BC
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:LINNE
Other - Last Name:BELEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:888-973-8821
Practice Address - Street 1:3700 PARK EAST DR STE 450
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4318
Practice Address - Country:US
Practice Address - Phone:668-490-6928
Practice Address - Fax:888-973-8821
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-21
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ322153363L00000X
COC-APN.0104342-C-NP363L00000X
IL209027334363L00000X
FLAPRN11020801363L00000X
OH15289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner