Provider Demographics
NPI:1174128342
Name:MORETZ, KAYLA LYNN (NP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:MORETZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:LYNN
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2426 KENWAY DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3423
Mailing Address - Country:US
Mailing Address - Phone:515-518-7477
Mailing Address - Fax:
Practice Address - Street 1:1251 W CEDAR LOOP
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1566
Practice Address - Country:US
Practice Address - Phone:712-225-2594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH156800363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care