Healthcare Provider Details

I. General information

NPI: 1760482426
Provider Name (Legal Business Name): DIANNE KAY KNAPP ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N MADISON ST
BLOOMFIELD IA
52537-1271
US

IV. Provider business mailing address

509 N MADISON ST
BLOOMFIELD IA
52537-1271
US

V. Phone/Fax

Practice location:
  • Phone: 641-664-3832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA047738
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1760482426
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier1184623985
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerMEDICARE
# 3
Identifier242195006
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: