=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992559371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLEA ADKINS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2024
-----------------------------------------------------
Last Update Date | 04/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 N QUINCY AVE STE 137
-----------------------------------------------------
City | OTTUMWA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52501-3864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-856-2688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1208
-----------------------------------------------------
City | OTTUMWA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52501-7208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-455-1396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 112930
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------