Healthcare Provider Details

I. General information

NPI: 1598445678
Provider Name (Legal Business Name): KHYLA MARIE KLINE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE STE 251
WEST BURLINGTON IA
52655-1688
US

IV. Provider business mailing address

427 2ND ST
WEST POINT IA
52656-9442
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-3700
  • Fax: 319-768-3712
Mailing address:
  • Phone: 319-371-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG176855
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: