Healthcare Provider Details

I. General information

NPI: 1407968704
Provider Name (Legal Business Name): KARLA KAY CHENEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S CLARK ST SUITE 100
CARROLL IA
51401-3065
US

IV. Provider business mailing address

1929 LOIS AVENUE
CARROLL IA
51401
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-2222
  • Fax: 712-792-3875
Mailing address:
  • Phone: 712-792-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28885
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: