Healthcare Provider Details

I. General information

NPI: 1275411993
Provider Name (Legal Business Name): ADDISON BENTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 100TH ST
URBANDALE IA
50322-7212
US

IV. Provider business mailing address

6001 WESTOWN PKWY
WEST DES MOINES IA
50266-7719
US

V. Phone/Fax

Practice location:
  • Phone: 515-224-1414
  • Fax: 515-224-5140
Mailing address:
  • Phone: 515-224-1414
  • Fax: 515-224-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number140858
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: