Carol Klocke, ARNP
Individual provider Active NPI Nurse Practitioner · Audubon, IA
NPI 1316901580 · NPPES record last updated Dec 10, 2007
Key facts
- NPI
- 1316901580
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- A069367 (IA)
- Practice address
- 515 Pacific Ave
Audubon, IA 50025-1052 - Phone
- (712) 563-2611
- Fax
- (712) 563-3078
- NPI assigned
- Apr 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A069367 | IA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alegent Creighton Clinic | Past | Accepting new patients | |
| Alegent Health Quick Care LLC | Nurse Practitioner | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | A069367 | IA | Yes |
Addresses
Primary practice location
515 Pacific Ave
Audubon, IA 50025-1052
Mailing address
515 Pacific Ave
Audubon, IA 50025-1052
Phone (712) 563-2611
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1452755 | Medicaid | IA |
Other providers in Audubon, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.