Healthcare Provider Details

I. General information

NPI: 1255212171
Provider Name (Legal Business Name): VANESSA LYNN PENICK MSN, ARNP, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

PO BOX 674721
DALLAS TX
75267-4721
US

V. Phone/Fax

Practice location:
  • Phone: 515-247-3057
  • Fax: 515-643-0943
Mailing address:
  • Phone: 515-643-2519
  • Fax: 515-643-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberH188625
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG08250005
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: