Provider Demographics
NPI:1154911865
Name:LAWRENCE, KAYLEY MORGAN (ARNP)
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:MORGAN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KAYLEY
Other - Middle Name:
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4543
Mailing Address - Country:US
Mailing Address - Phone:319-233-0340
Mailing Address - Fax:319-233-0666
Practice Address - Street 1:1717 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4543
Practice Address - Country:US
Practice Address - Phone:319-233-0340
Practice Address - Fax:319-233-0666
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA160749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA144415OtherRN LICENSE
IAA160749OtherARNP LICENSE