Healthcare Provider Details

I. General information

NPI: 1265336143
Provider Name (Legal Business Name): JEMAR CONARD STANTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 SW 9TH ST
DES MOINES IA
50315-1506
US

IV. Provider business mailing address

2117 SW 9TH ST
DES MOINES IA
50315-1506
US

V. Phone/Fax

Practice location:
  • Phone: 515-343-0879
  • Fax:
Mailing address:
  • Phone: 515-343-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number331KK3859
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: