Healthcare Provider Details

I. General information

NPI: 1669223038
Provider Name (Legal Business Name): GUIDED ASCENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8191 BIRCHWOOD CT UNIT A
JOHNSTON IA
50131-2931
US

IV. Provider business mailing address

809 KINGMAN BLVD
MADRID IA
50156-1424
US

V. Phone/Fax

Practice location:
  • Phone: 515-664-7386
  • Fax:
Mailing address:
  • Phone: 515-664-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: COURTNEY MARIE FULLER
Title or Position: CEO
Credential: RN
Phone: 515-249-3338