Provider Demographics
NPI:1013989904
Name:CORE, KATHLEEN M (ARNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2563 HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50115-8880
Mailing Address - Country:US
Mailing Address - Phone:641-747-8099
Mailing Address - Fax:
Practice Address - Street 1:710 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-1544
Practice Address - Country:US
Practice Address - Phone:641-332-2201
Practice Address - Fax:641-332-2276
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA063765363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35364OtherWELLMARK
IAIA0105OtherJOHN DEERE
IA0267575Medicaid
IAP01703Medicare UPIN
IA0267575Medicaid