Healthcare Provider Details

I. General information

NPI: 1497853584
Provider Name (Legal Business Name): KAY LYNN CAMPBELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY LYNN CLARK CRNA

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 WESTOWN PKWY SUITE 210
WEST DES MOINES IA
50266-8218
US

IV. Provider business mailing address

5901 WESTOWN PKWY 210
WEST DES MOINES IA
50266-8218
US

V. Phone/Fax

Practice location:
  • Phone: 515-221-9222
  • Fax: 515-221-0575
Mailing address:
  • Phone: 515-221-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD-062974
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: