Provider Demographics
NPI:1710415005
Name:AVERY, KRISTIN (DO)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:WEIGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-2303
Mailing Address - Country:US
Mailing Address - Phone:641-357-7442
Mailing Address - Fax:
Practice Address - Street 1:401 S 15TH ST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-2303
Practice Address - Country:US
Practice Address - Phone:641-357-7442
Practice Address - Fax:641-357-3070
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10935208000000X
IA05513208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics