Provider Demographics
NPI:1063263630
Name:GARVER, KACIE MARIE
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:MARIE
Last Name:GARVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4898
Mailing Address - Country:US
Mailing Address - Phone:515-432-3140
Mailing Address - Fax:
Practice Address - Street 1:1015 UNION ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4821
Practice Address - Country:US
Practice Address - Phone:515-432-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121524163W00000X
IAW178892364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse