Healthcare Provider Details

I. General information

NPI: 1760961981
Provider Name (Legal Business Name): HEATHER GUMMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 WALNUT ST STE 400
DES MOINES IA
50309-3962
US

IV. Provider business mailing address

PO BOX 153
WILLOW SPRINGS MO
65793-0153
US

V. Phone/Fax

Practice location:
  • Phone: 515-441-7944
  • Fax:
Mailing address:
  • Phone: 515-441-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG189695
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: