Healthcare Provider Details

I. General information

NPI: 1104032002
Provider Name (Legal Business Name): KATHRYN ANNE KVEDERIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 DRUID HILL DR
DES MOINES IA
50315-2122
US

IV. Provider business mailing address

3105 DRUID HILL DR
DES MOINES IA
50315-2122
US

V. Phone/Fax

Practice location:
  • Phone: 515-457-8030
  • Fax: 515-244-2507
Mailing address:
  • Phone: 515-457-8030
  • Fax: 515-244-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number30740
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG54607
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2005-0425
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: