Healthcare Provider Details

I. General information

NPI: 1063263630
Provider Name (Legal Business Name): KACIE MARIE GARVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 UNION ST
BOONE IA
50036-4821
US

IV. Provider business mailing address

1015 UNION ST
BOONE IA
50036-4898
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-3140
  • Fax:
Mailing address:
  • Phone: 515-432-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberW178892
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number121524
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: