Healthcare Provider Details

I. General information

NPI: 1962184929
Provider Name (Legal Business Name): JESSICA LYNN HART ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 8TH AVE W
CRESCO IA
52136-1064
US

IV. Provider business mailing address

321 8TH AVE W
CRESCO IA
52136-1064
US

V. Phone/Fax

Practice location:
  • Phone: 563-547-2022
  • Fax: 563-547-3448
Mailing address:
  • Phone: 563-547-2022
  • Fax: 563-547-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA175739
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number154025
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: