Provider Demographics
NPI:1144873282
Name:LAVILLE THOREN, KENNEDY (DNP, ARNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:
Last Name:LAVILLE THOREN
Suffix:
Gender:F
Credentials:DNP, ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1004
Mailing Address - Country:US
Mailing Address - Phone:515-243-5181
Mailing Address - Fax:515-309-0555
Practice Address - Street 1:1089 JORDAN CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5830
Practice Address - Country:US
Practice Address - Phone:515-531-8013
Practice Address - Fax:833-983-2836
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG159113363LP0808X
IA140115163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse