Healthcare Provider Details

I. General information

NPI: 1144873282
Provider Name (Legal Business Name): KENNEDY LAVILLE THOREN DNP, ARNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S 19TH ST
NEVADA IA
50201-2902
US

IV. Provider business mailing address

1301 CENTER ST
DES MOINES IA
50309-1004
US

V. Phone/Fax

Practice location:
  • Phone: 515-382-5413
  • Fax: 515-382-7107
Mailing address:
  • Phone: 515-243-5181
  • Fax: 515-309-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG159113
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number140115
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: