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General NPI Number Information
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NPI Number | 1225974892
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Entity Type | Organization
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Legal Business Name | BLOOM PEDIATRICS OF SOUTHERN IOWA PLLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 925 CHURCH ST
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City | OTTUMWA
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State | IA
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Zip | 52501-4223
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Country | US
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Telephone | 641-814-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 925 CHURCH ST
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City | OTTUMWA
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State | IA
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Zip | 52501-4223
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Country | US
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Telephone | 641-814-5437
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Fax |
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Authorized Official
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Title or Position | ARNP
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Name | JACY L KENNEDY
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Credential | ARNP
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Telephone | 641-226-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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