Individual provider Active NPI

Kristin M. Devore, A.R.N.P.

  • Pediatric Nurse Practitioner
  • Hiawatha, IA
National Provider Identifier
1619213584
Registry record updated Mar 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
C114040 Issued in IA
Practice address
1075 N Center Point Rd
Hiawatha, IA 52233-1231
Phone
(319) 743-1440
Fax
(319) 733-1444
NPI assigned
Dec 21, 2012
Last updated
Mar 29, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X C114040 IA Primary

Addresses

Primary practice location

1075 N Center Point Rd
Hiawatha, IA 52233-1231

Mailing address

1075 N Center Point Rd
Hiawatha, IA 52233-1231
Phone (319) 743-1440

Other identifiers 1

IdentifierTypeStateIssuer
1619213584MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130322000019 IA Practitioner - Nurse Practitioner 7911142914 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1075 N Ctr Point Rd
Pediatrics Hiawatha
Hiawatha, IA 52233-1231
Phone (319) 743-1440

4480 Utica Ridge Rd
Bettendorf, IA 52722-1644

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
C114040IAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation CurrentSince Feb 28, 2013 Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

1075 N Center Point Rd
Hiawatha, IA 52233
Phone (319) 743-1440

Interoperability endpoints

  • Direct secure messaging: kdevore132471@direct.unitypoint.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364515200000",
    "number": "1619213584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 N CENTER POINT RD",
            "city": "HIAWATHA",
            "state": "IA",
            "postal_code": "522331231",
            "telephone_number": "319-743-1440",
            "fax_number": "319-733-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 N CENTER POINT RD",
            "city": "HIAWATHA",
            "state": "IA",
            "postal_code": "522331231",
            "telephone_number": "319-743-1440",
            "fax_number": "319-733-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVORE",
        "first_name": "KRISTIN",
        "middle_name": "M.",
        "credential": "A.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-21",
        "last_updated": "2013-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IA",
            "license": "C114040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619213584",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hiawatha, IA

Sources for this page

Verify at the official NPI Registry.