Healthcare Provider Details

I. General information

NPI: 1245017888
Provider Name (Legal Business Name): MICAYLA AMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

713 SE 3RD ST
GRIMES IA
50111-1010
US

V. Phone/Fax

Practice location:
  • Phone: 515-341-1368
  • Fax:
Mailing address:
  • Phone: 515-341-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG186915
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number148547
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: