Provider Demographics
NPI:1639610603
Name:LAWRANCE, KAYLA JOLENE (CNM)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JOLENE
Last Name:LAWRANCE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1537
Mailing Address - Country:US
Mailing Address - Phone:641-660-1688
Mailing Address - Fax:
Practice Address - Street 1:3714 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3411
Practice Address - Country:US
Practice Address - Phone:515-309-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5377612032367A00000X
IAB106011367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife