=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629998091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALLORY KLEIN
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2026
-----------------------------------------------------
Last Update Date | 07/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 709 W MAIN ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52057-1526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-927-3232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3247 130TH AVE
-----------------------------------------------------
City | RYAN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52330-8526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | A192530
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------