Healthcare Provider Details

I. General information

NPI: 1275834012
Provider Name (Legal Business Name): JODY L KAPUSTKA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODY KAPUSTKA

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 02/27/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DUFF AVE
AMES IA
50010-5745
US

IV. Provider business mailing address

2521 UNIVERSITY BLVD STE 121
AMES IA
50010-8629
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-2011
  • Fax:
Mailing address:
  • Phone: 515-292-2150
  • Fax: 515-292-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG-102777
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: