Provider Demographics
NPI:1487170718
Name:BEMENT, KELLIE K (DNP, ARNP)
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:K
Last Name:BEMENT
Suffix:
Gender:
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:K
Other - Last Name:WAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, ARNP
Mailing Address - Street 1:6750 WESTOWN PARKWAY #200
Mailing Address - Street 2:BOX 134
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-558-6865
Mailing Address - Fax:
Practice Address - Street 1:4401 WESTOWN PKWY STE 108
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6721
Practice Address - Country:US
Practice Address - Phone:515-493-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104780163W00000X
IAA104780363LF0000X
IAG176775363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily