Provider Demographics
NPI:1972034528
Name:KLEINMEYER, MISTY
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:KLEINMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 DOUGLASS CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-5402
Mailing Address - Country:US
Mailing Address - Phone:319-270-8198
Mailing Address - Fax:
Practice Address - Street 1:310 DOUGLASS CT
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-5402
Practice Address - Country:US
Practice Address - Phone:319-270-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD155099367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered