Provider Demographics
NPI:1548215833
Name:BOONE, COSETTE KAE (ARNP, CNM)
Entity Type:Individual
Prefix:
First Name:COSETTE
Middle Name:KAE
Last Name:BOONE
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 19TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1112
Mailing Address - Country:US
Mailing Address - Phone:515-266-6712
Mailing Address - Fax:515-244-2333
Practice Address - Street 1:733 19TH ST # 1
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1039
Practice Address - Country:US
Practice Address - Phone:515-266-6712
Practice Address - Fax:515-283-2502
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-100222367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife