Healthcare Provider Details

I. General information

NPI: 1700806262
Provider Name (Legal Business Name): COLLETTE SMITH MCCULLOUGH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 5TH ST
SIOUX CITY IA
51101-1317
US

IV. Provider business mailing address

800 5TH ST
SIOUX CITY IA
51101-1317
US

V. Phone/Fax

Practice location:
  • Phone: 712-202-0777
  • Fax:
Mailing address:
  • Phone: 712-202-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberZ-053998
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberZ-053998
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number053998
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: