Healthcare Provider Details

I. General information

NPI: 1326550922
Provider Name (Legal Business Name): KATIE M DEAN PNP-AC, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2017
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 DOUGLAS AVE STE 101
DES MOINES IA
50310-2760
US

IV. Provider business mailing address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

V. Phone/Fax

Practice location:
  • Phone: 515-724-8920
  • Fax:
Mailing address:
  • Phone: 515-241-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC117312
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number117312
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: