Provider Demographics
NPI:1538167887
Name:BOOTE, KIMBERLY A (CNM)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BOOTE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 KING DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5956
Mailing Address - Country:US
Mailing Address - Phone:319-234-5764
Mailing Address - Fax:319-234-1336
Practice Address - Street 1:432 KING DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5956
Practice Address - Country:US
Practice Address - Phone:319-234-5764
Practice Address - Fax:319-234-1336
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-100517367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0417469Medicaid
IA0147OtherJOHN DEERE
IA0076372Medicaid