Provider Demographics
NPI:1134171937
Name:FLANDERS, KATHRYN LEE (ARNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEE
Last Name:FLANDERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
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:319-356-3071
Mailing Address - Fax:319-356-1675
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:319-356-3071
Practice Address - Fax:319-356-1675
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF053245363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09615OtherWELLMARK BCBS
IA1222976Medicaid
S86307Medicare UPIN
IA1222976Medicaid