Healthcare Provider Details

I. General information

NPI: 1497550164
Provider Name (Legal Business Name): JESSICA LEIGH BRASSFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 N DAVIS ST
BLOOMFIELD IA
52537-1105
US

IV. Provider business mailing address

706 N DAVIS ST
BLOOMFIELD IA
52537-1105
US

V. Phone/Fax

Practice location:
  • Phone: 319-521-5221
  • Fax:
Mailing address:
  • Phone: 319-521-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG182674
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: