Basic Information
| Provider Information | |||||||||
| NPI: | 1275916272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAURER | ||||||||
| FirstName: | KYLIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WOODLEY | ||||||||
| OtherFirstName: | KYLIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 608 NW 7TH ST | ||||||||
| Address2: | |||||||||
| City: | POCAHONTAS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505741000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123355632 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 608 NW 7TH ST | ||||||||
| Address2: | |||||||||
| City: | POCAHONTAS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505741000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123355632 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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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 | 363A00000X | 078744 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.