Healthcare Provider Details

I. General information

NPI: 1801566054
Provider Name (Legal Business Name): CRYSTAL LYNN MICK ARNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL LYNN PESTER

II. Dates (important events)

Enumeration Date: 09/19/2021
Last Update Date: 09/24/2026
Certification Date: 04/11/2025
Deactivation Date: 09/24/2026
Reactivation Date: 09/24/2026

III. Provider practice location address

1 JACK FOSTER DR
SHENANDOAH IA
51601-4586
US

IV. Provider business mailing address

1 JACK FOSTER DR
SHENANDOAH IA
51601-4586
US

V. Phone/Fax

Practice location:
  • Phone: 712-246-7215
  • Fax: 712-246-7319
Mailing address:
  • Phone: 712-246-7215
  • Fax: 712-246-7319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number141195
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG168071
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: