Healthcare Provider Details

I. General information

NPI: 1003765124
Provider Name (Legal Business Name): KALLIE LYNNE VAN KLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 7TH ST SW
ORANGE CITY IA
51041-1923
US

IV. Provider business mailing address

4683 LEGION ST UNIT 60
NEWTON IA
50208-8742
US

V. Phone/Fax

Practice location:
  • Phone: 712-707-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: