Healthcare Provider Details

I. General information

NPI: 1114603867
Provider Name (Legal Business Name): KATHRYN GENEVIEVE DEMPSEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN GENEVIEVE BOTKIN

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S 6TH ST
COUNCIL BLUFFS IA
51501-6441
US

IV. Provider business mailing address

902 S 6TH ST
COUNCIL BLUFFS IA
51501-6441
US

V. Phone/Fax

Practice location:
  • Phone: 712-325-1990
  • Fax:
Mailing address:
  • Phone: 712-325-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number129796
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: