Healthcare Provider Details

I. General information

NPI: 1538167887
Provider Name (Legal Business Name): KIMBERLY A BOOTE C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 KING DR
WATERLOO IA
50702-5956
US

IV. Provider business mailing address

432 KING DR
WATERLOO IA
50702-5956
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-5764
  • Fax: 319-234-1336
Mailing address:
  • Phone: 319-234-5764
  • Fax: 319-234-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberB-100517
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: