Provider Demographics
NPI:1619213584
Name:DEVORE, KRISTIN M (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:DEVORE
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 1:1075 N CENTER POINT RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1231
Mailing Address - Country:US
Mailing Address - Phone:319-743-1440
Mailing Address - Fax:319-733-1444
Practice Address - Street 1:1075 N CENTER POINT RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1231
Practice Address - Country:US
Practice Address - Phone:319-743-1440
Practice Address - Fax:319-733-1444
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC114040363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1619213584Medicaid
IA719260561Medicare PIN