Provider Demographics
NPI:1598501843
Name:KILBOURN, STEPHANY DANIELLE (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:DANIELLE
Last Name:KILBOURN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:DANIELL
Other - Last Name:GAIKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2800
Mailing Address - Country:US
Mailing Address - Phone:641-428-3041
Mailing Address - Fax:
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2800
Practice Address - Country:US
Practice Address - Phone:641-428-3041
Practice Address - Fax:641-428-3059
Is Sole Proprietor?:No
Enumeration Date:2024-07-06
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-83314-011363LW0102X
IAF180109363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health