Basic Information
| Provider Information | |||||||||
| NPI: | 1013143999 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIERKS | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1227 E RUSHOLME ST | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528032459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634216610 | ||||||||
| FaxNumber: | 5634217710 | ||||||||
| Practice Location | |||||||||
| Address1: | 1227 E RUSHOLME ST | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634216610 | ||||||||
| FaxNumber: | 5634217710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2009 | ||||||||
| LastUpdateDate: | 04/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | R-8630 | IA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 4179 | IA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.