Provider Demographics
NPI:1275113219
Name:KMC NP LLC
Entity Type:Organization
Organization Name:KMC NP LLC
Other - Org Name:KMC NP LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAFARO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:507-720-5500
Mailing Address - Street 1:8062 NE 30TH PL
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-8849
Mailing Address - Country:US
Mailing Address - Phone:507-720-5500
Mailing Address - Fax:
Practice Address - Street 1:8062 NE 30TH PL
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-8849
Practice Address - Country:US
Practice Address - Phone:507-720-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1942642426Medicaid
IA1275113219Medicaid