Provider Demographics
NPI:1649641978
Name:STEVENS, KELLY LYNN (RPH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9106
Mailing Address - Country:US
Mailing Address - Phone:319-334-5208
Mailing Address - Fax:319-334-5457
Practice Address - Street 1:2277 IOWA AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9106
Practice Address - Country:US
Practice Address - Phone:319-334-5208
Practice Address - Fax:319-334-5457
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA194071835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric