Provider Demographics
NPI:1265162994
Name:GERHART, AMY KALLISTA (BSN, RN, CNRN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KALLISTA
Last Name:GERHART
Suffix:
Gender:F
Credentials:BSN, RN, CNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SW 12TH ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4317
Mailing Address - Country:US
Mailing Address - Phone:507-993-8070
Mailing Address - Fax:
Practice Address - Street 1:412 SW 12TH ST UNIT 106
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4317
Practice Address - Country:US
Practice Address - Phone:507-993-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00381300163WN0800X
IA164264163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience