1013459635 NPI number — KAYLA KLEIHAUER M.ED., LAT, ATC, EMT

Table of content: (NPI 1720514953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013459635 NPI number — KAYLA KLEIHAUER M.ED., LAT, ATC, EMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIHAUER
Provider First Name:
KAYLA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LAT, ATC, EMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013459635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5921 SE 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50320-1746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5921 SE 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50320-1746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-953-0024
Provider Business Practice Location Address Fax Number:
515-953-0257
Provider Enumeration Date:
11/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  000945 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2000006151 . This is a "CERTIFIED ATHLETIC TRAINER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 000945 . This is a "LICENSED ATHLETIC TRAINER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: B-11-350-21 . This is a "EMERGENCY MEDICAL TECHNICIAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com