Provider Demographics
NPI:1497853584
Name:CAMPBELL, KAY LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:LYNN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5901 WESTOWN PKWY
Mailing Address - Street 2:210
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8218
Mailing Address - Country:US
Mailing Address - Phone:515-221-9222
Mailing Address - Fax:
Practice Address - Street 1:5901 WESTOWN PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8218
Practice Address - Country:US
Practice Address - Phone:515-221-9222
Practice Address - Fax:515-221-0575
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-062974367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0515506Medicaid
IA0515506Medicaid