Healthcare Provider Details

I. General information

NPI: 1770089641
Provider Name (Legal Business Name): RACHAEL DIRKX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL REICKS

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S CLARK ST STE 205
CARROLL IA
51401-3047
US

IV. Provider business mailing address

PO BOX 9170
DES MOINES IA
50306-9170
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-6500
  • Fax: 515-246-4481
Mailing address:
  • Phone: 515-633-3600
  • Fax: 515-633-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008652
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number110533
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: