Provider Demographics
NPI:1285025353
Name:DEKOCK, KALLIE (ARNP)
Entity Type:Individual
Prefix:
First Name:KALLIE
Middle Name:
Last Name:DEKOCK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 MERLE HAY RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1209
Mailing Address - Country:US
Mailing Address - Phone:515-727-6617
Mailing Address - Fax:515-727-8757
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:MAIN 3
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314
Practice Address - Country:US
Practice Address - Phone:515-247-3330
Practice Address - Fax:515-643-2219
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC138665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner