Healthcare Provider Details

I. General information

NPI: 1477291094
Provider Name (Legal Business Name): AMY LEIGH KENYON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

1111 6TH AVE
DES MOINES IA
50314-2613
US

V. Phone/Fax

Practice location:
  • Phone: 515-358-4000
  • Fax: 515-358-4099
Mailing address:
  • Phone: 515-358-4000
  • Fax: 515-358-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberK170246
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number113760
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: