Healthcare Provider Details

I. General information

NPI: 1144993486
Provider Name (Legal Business Name): NIKALA PRASASOUK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 100TH ST
URBANDALE IA
50322-7208
US

IV. Provider business mailing address

4706 ASPEN DR
WEST DES MOINES IA
50265-2923
US

V. Phone/Fax

Practice location:
  • Phone: 515-675-7500
  • Fax:
Mailing address:
  • Phone: 515-664-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA164654
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: