Healthcare Provider Details

I. General information

NPI: 1851831499
Provider Name (Legal Business Name): LACEY RAE CHEESEMAN ARNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACEY RAE COQUELIN

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 SW MAGAZINE RD
ANKENY IA
50023-2978
US

IV. Provider business mailing address

701 NW BOULDER BROOK DR
ANKENY IA
50023-8725
US

V. Phone/Fax

Practice location:
  • Phone: 515-348-6380
  • Fax: 515-452-0565
Mailing address:
  • Phone: 515-423-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG178631
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA109462
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: