Provider Demographics
NPI:1548905748
Name:HAUT, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HAUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 7TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:TRIPOLI
Mailing Address - State:IA
Mailing Address - Zip Code:50676-9700
Mailing Address - Country:US
Mailing Address - Phone:319-882-8534
Mailing Address - Fax:
Practice Address - Street 1:602 7TH AVE SW
Practice Address - Street 2:
Practice Address - City:TRIPOLI
Practice Address - State:IA
Practice Address - Zip Code:50676-9700
Practice Address - Country:US
Practice Address - Phone:319-882-8534
Practice Address - Fax:319-272-3850
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA165655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily