Basic Information
| Provider Information | |||||||||
| NPI: | 1245269489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEGIVERN | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2710 SAINT FRANCIS DR STE 111 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192727425 | ||||||||
| FaxNumber: | 3192728059 | ||||||||
| Practice Location | |||||||||
| Address1: | 2710 SAINT FRANCIS DR STE 111 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192727425 | ||||||||
| FaxNumber: | 3192728059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO-02122 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6023333 | 05 | IA | MEDICAID |