MEDICARE: MOONSTONE MENTAL HEALTH SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1447064928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONSTONE MENTAL HEALTH SERVICES PLLC

Provider Business Mailing Address
First Line	:	1566 S GILBERT ST UNIT 1023
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4304
Country	:	US
Telephone Number	:	319-853-8378
Fax Number	:

Provider Business Practice Location Address
First Line	:	1566 S GILBERT ST UNIT 1023
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4304
Country	:	US
Telephone Number	:	319-853-8378
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KADESHA EVANS
Credential	:	APRN
Telephone Number	:	319-853-8378

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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