Provider Demographics
NPI:1497004279
Name:HILDRETH-ROTHMEIER, KYLIE JANE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:JANE
Last Name:HILDRETH-ROTHMEIER
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:PO BOX 71602
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-0602
Mailing Address - Country:US
Mailing Address - Phone:515-243-2057
Mailing Address - Fax:515-244-5570
Practice Address - Street 1:401 COURT STREET
Practice Address - Street 2:
Practice Address - City:ROCKWELL CITY
Practice Address - State:IA
Practice Address - Zip Code:50579-1534
Practice Address - Country:US
Practice Address - Phone:712-297-2026
Practice Address - Fax:712-297-2019
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-115424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1689041329Medicaid
IA1497004279OtherBCBS
IA1689041329Medicaid