Healthcare Provider Details

I. General information

NPI: 1447246020
Provider Name (Legal Business Name): DAVID L KEARNS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 IOWA AVE
IOWA CITY IA
52240-1833
US

IV. Provider business mailing address

511 IOWA AVE
IOWA CITY IA
52240-1833
US

V. Phone/Fax

Practice location:
  • Phone: 319-354-8906
  • Fax:
Mailing address:
  • Phone: 319-354-8906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00752
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: