Provider Demographics
NPI:1396706362
Name:HORNBROOK, KAYLEEN BETH (DO)
Entity type:Individual
Prefix:
First Name:KAYLEEN
Middle Name:BETH
Last Name:HORNBROOK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:1360 NW 18TH ST STE 102
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9105
Practice Address - Country:US
Practice Address - Phone:515-875-9730
Practice Address - Fax:515-875-9731
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR7044207Q00000X
IA3587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1396706362Medicaid
IA0456244Medicaid
IAI14686Medicare PIN
IA1396706362Medicaid
IA719260245Medicare PIN