Healthcare Provider Details

I. General information

NPI: 1225974546
Provider Name (Legal Business Name): KIMBERLEE ANN HEWLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLEE GAVLICK

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N MAIN ST
WALCOTT IA
52773-9798
US

IV. Provider business mailing address

245 N MAIN ST
WALCOTT IA
52773-9798
US

V. Phone/Fax

Practice location:
  • Phone: 856-296-1023
  • Fax:
Mailing address:
  • Phone: 856-296-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: