MEDICARE: KAYE M CLEVELAND ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A063458	IA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	A063458	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34971	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1063497840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYE M CLEVELAND ARNP

Provider Business Mailing Address
First Line	:	603 N ADAMS ST
Second Line	:
City	:	CARROLL
State	:	IA
Zip	:	51401-2344
Country	:	US
Telephone Number	:	712-525-0993
Fax Number	:	712-525-9137

Provider Business Practice Location Address
First Line	:	3202 LEONA DR
Second Line	:
City	:	STORM LAKE
State	:	IA
Zip	:	50588-2761
Country	:	US
Telephone Number	:	515-408-3178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	12/20/2024

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