Healthcare Provider Details

I. General information

NPI: 1669056123
Provider Name (Legal Business Name): KAMA SARAH AUSBORN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 HOME PLZ STE 301
WATERLOO IA
50701-4822
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-299-2864
  • Fax: 866-761-0459
Mailing address:
  • Phone: 319-235-5390
  • Fax: 866-761-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number141468
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG164101
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: