Provider Demographics
NPI:1558198317
Name:VAN BLARICOME, KAYLA (RN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:VAN BLARICOME
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3291 KELLY LN
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52553-9702
Mailing Address - Country:US
Mailing Address - Phone:641-799-7065
Mailing Address - Fax:
Practice Address - Street 1:3291 KELLY LN
Practice Address - Street 2:
Practice Address - City:EDDYVILLE
Practice Address - State:IA
Practice Address - Zip Code:52553-9702
Practice Address - Country:US
Practice Address - Phone:641-799-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA166912163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse