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NPI Code Detail

MEDICARE: NICOLE KEHOE LISW

MEDICARE: NICOLE KEHOE LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker03738IA

General Provider Information

NPI Number : 1205883303
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE KEHOE LISW
Provider Business Mailing Address
First Line : 1200 UNIVERSITY AVE STE 200
Second Line :
City : DES MOINES
State : IA
Zip : 50314-2355
Country : US
Telephone Number : 515-248-1447
Fax Number : 515-248-1440
Provider Business Practice Location Address
First Line : 3509 E 29TH ST
Second Line :
City : DES MOINES
State : IA
Zip : 50317-4253
Country : US
Telephone Number : 515-248-1600
Fax Number : 515-248-1610
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 05/03/2024

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1356315824 — DIANE E CLEVENGER ARNP
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1699728287 — LOUISE M CONVERY D.O.
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1689603201 — MS. NANCY ANN THURTELL ARNP
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Directions to “ NICOLE KEHOE LISW” Practice Location

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