Provider Demographics
NPI:1649258815
Name:MCKINSTRY, ANN C (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:C
Last Name:MCKINSTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S BLAIRSFERRY XING
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-7988
Mailing Address - Country:US
Mailing Address - Phone:515-471-9372
Mailing Address - Fax:515-471-9319
Practice Address - Street 1:400 S BLAIRSFERRY XING
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-7986
Practice Address - Country:US
Practice Address - Phone:319-393-0783
Practice Address - Fax:319-393-0427
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080137664OtherRR MEDICARE
IA1145698Medicaid
IA49693Medicare PIN
IA1145698Medicaid