Individual
KIM K COUNTRYMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
120 NE DARTMOOR DR, WAUKEE, IA 50263
(515) 875-9890
(515) 875-9892
Mailing address
7147 VISTA DR STE 150, WEST DES MOINES, IA 50266-9313
(515) 875-9925
(515) 875-9923
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO-02312
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043646
—
IA
01
—
59276
WELLMARK BCBS
IN
Enumeration date
08/03/2005
Last updated
10/19/2022
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