Healthcare Provider Details

I. General information

NPI: 1104590686
Provider Name (Legal Business Name): MCKENZIE D WOODYARD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 11/28/2024
Certification Date: 11/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LOCUST ST
DES MOINES IA
50309-4104
US

IV. Provider business mailing address

PO BOX 672
ANKENY IA
50021-0672
US

V. Phone/Fax

Practice location:
  • Phone: 515-805-0956
  • Fax: 515-335-2298
Mailing address:
  • Phone: 515-805-0956
  • Fax: 515-335-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberG164206
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG164206
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: