Provider Demographics
NPI:1790774818
Name:WARD, KELLY KAY (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KAY
Last Name:WARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KAY
Other - Last Name:WARD SCHMIERER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-1279
Mailing Address - Fax:319-384-5164
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-1279
Practice Address - Fax:319-384-5164
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35658207VX0000X
IAMD-35658207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0441048Medicaid
IA36514OtherWELLMARK BCBS
IA36514OtherWELLMARK BCBS
IAI12635Medicare PIN
I07652Medicare UPIN