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: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 220
CEDAR RAPIDS IA
52402-3221
US

IV. Provider business mailing address

4403 1ST AVE SE STE 220
CEDAR RAPIDS IA
52402-3221
US

V. Phone/Fax

Practice location:
  • Phone: 319-900-4525
  • Fax: 319-303-7070
Mailing address:
  • Phone: 319-900-4525
  • Fax: 319-303-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG160805
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: