Healthcare Provider Details

I. General information

NPI: 1437721446
Provider Name (Legal Business Name): JESSICA LOUISE ELLENSOHN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DUFF AVE
AMES IA
50010-5745
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5469
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4401
  • Fax: 515-239-4791
Mailing address:
  • Phone: 515-239-4400
  • Fax: 515-956-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH164472
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberH164472
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: