Healthcare Provider Details

I. General information

NPI: 1174137061
Provider Name (Legal Business Name): KRISTINA GATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 33RD AVE SW STE S
CEDAR RAPIDS IA
52404-4646
US

IV. Provider business mailing address

260 33RD AVE SW STE X
CEDAR RAPIDS IA
52404-4646
US

V. Phone/Fax

Practice location:
  • Phone: 319-560-5523
  • Fax: 319-403-0121
Mailing address:
  • Phone: 319-560-5523
  • Fax: 319-403-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number118238
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG160805
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: