Provider Demographics
NPI:1487383501
Name:BRAVEK, KAITLYN SIERRA
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:SIERRA
Last Name:BRAVEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-1645
Mailing Address - Country:US
Mailing Address - Phone:515-386-2114
Mailing Address - Fax:515-386-3695
Practice Address - Street 1:1000 W LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1645
Practice Address - Country:US
Practice Address - Phone:515-386-2114
Practice Address - Fax:515-386-3695
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant