Healthcare Provider Details

I. General information

NPI: 1790613925
Provider Name (Legal Business Name): LEVI GARRETT STACKEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HICKMAN RD
DES MOINES IA
50314-1597
US

IV. Provider business mailing address

1801 HICKMAN RD
DES MOINES IA
50314-1597
US

V. Phone/Fax

Practice location:
  • Phone: 515-282-2200
  • Fax:
Mailing address:
  • Phone: 515-282-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-14024
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: