Healthcare Provider Details

I. General information

NPI: 1245655265
Provider Name (Legal Business Name): KATHLEEN MEDD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY MEDD ARNP

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E DONALD ST
WATERLOO IA
50703
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-236-1911
  • Fax:
Mailing address:
  • Phone: 319-236-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberL103231
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberL-103231
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: