Provider Demographics
NPI:1407968704
Name:CHENEY, KARLA KAY (MD)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:KAY
Last Name:CHENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 LOIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401
Mailing Address - Country:US
Mailing Address - Phone:712-792-8152
Mailing Address - Fax:
Practice Address - Street 1:405 S CLARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3065
Practice Address - Country:US
Practice Address - Phone:712-792-2222
Practice Address - Fax:712-792-3875
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35947OtherWELLMARK
NE42146645100Medicaid
NE35947OtherWELLMARK
F62286Medicare UPIN