Gradoville, Kathleen
Gradoville, Kathleen is an individual health care provider with primary practice located at 1212 Pleasant St Suite 204, Des Moines IA 50309-1453. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Gradoville, Kathleen can be contacted via phone (515) 241-6548.Contact Information
Primary practice address
1212 Pleasant St Suite 204
Des Moines IA 50309-1453
Phone: (515) 241-6548
Fax: (515) 241-8789
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | C81143 | Iowa |
Profile Details
| NPI number | 1285626390 |
|---|---|
| LBN Legal business name | Gradoville, Kathleen |
| Credentials | ARNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 16th, 2005 |
| Last updated | Nov 18th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285626390 | NPPES |
| Missouri | MEDICAID | 1285626390 | |
| Missouri | Other | 17515013 | |
| Missouri | MEDICAID | 1285626390 |
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