Healthcare Provider Details

I. General information

NPI: 1952256604
Provider Name (Legal Business Name): CAROLYNN JELAGAT KEMBOI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 NE 15TH ST
ANKENY IA
50021-9632
US

IV. Provider business mailing address

4313 NE 15TH ST
ANKENY IA
50021-9632
US

V. Phone/Fax

Practice location:
  • Phone: 614-779-6842
  • Fax: 614-779-6842
Mailing address:
  • Phone: 614-779-6842
  • Fax: 614-779-6842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: