Healthcare Provider Details

I. General information

NPI: 1053935890
Provider Name (Legal Business Name): NICK STULL ARNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 LINCOLN WAY STE 4
AMES IA
50014-7595
US

IV. Provider business mailing address

3600 LINCOLN WAY STE 4
AMES IA
50014-7595
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4410
  • Fax: 515-663-4885
Mailing address:
  • Phone: 515-239-4410
  • Fax: 515-663-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG159093
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: