Healthcare Provider Details

I. General information

NPI: 1366283707
Provider Name (Legal Business Name): CASEY ELIZABETH PEPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 COVE DR UNIT 204N
AMES IA
50010-2325
US

IV. Provider business mailing address

812 COVE DR
AMES IA
50010-2324
US

V. Phone/Fax

Practice location:
  • Phone: 319-572-2295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: