Provider Demographics
NPI:1508046269
Name:DEVINE, KATHY MCCORMICK (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:MCCORMICK
Last Name:DEVINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:MCCORMICK-DEOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:221 E COLLEGE ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-1699
Mailing Address - Country:US
Mailing Address - Phone:319-337-3313
Mailing Address - Fax:319-337-0686
Practice Address - Street 1:221 E COLLEGE ST
Practice Address - Street 2:SUITE 211
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-1699
Practice Address - Country:US
Practice Address - Phone:319-337-3313
Practice Address - Fax:319-337-0686
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB109663367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife