Healthcare Provider Details

I. General information

NPI: 1669626396
Provider Name (Legal Business Name): KARLA A MRACEK-KNIGHT LISW, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E COURT AVE STE 236
DES MOINES IA
50309-2023
US

IV. Provider business mailing address

4505 29TH ST
DES MOINES IA
50310-5824
US

V. Phone/Fax

Practice location:
  • Phone: 515-650-1812
  • Fax:
Mailing address:
  • Phone: 563-380-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number001841
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082963
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: