Healthcare Provider Details

I. General information

NPI: 1275113219
Provider Name (Legal Business Name): KMC NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 42ND ST STE 408
WEST DES MOINES IA
50266-1005
US

IV. Provider business mailing address

1501 42ND ST STE 408
WEST DES MOINES IA
50266-1005
US

V. Phone/Fax

Practice location:
  • Phone: 515-599-0369
  • Fax: 979-256-0890
Mailing address:
  • Phone: 515-599-0369
  • Fax: 979-256-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CAFARO
Title or Position: OWNER
Credential: ARNP
Phone: 515-599-0369