Healthcare Provider Details

I. General information

NPI: 1720515836
Provider Name (Legal Business Name): JESSICA KOPPEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W HICKMAN RD
WAUKEE IA
50263
US

IV. Provider business mailing address

PO BOX 1475
DES MOINES IA
50305-1475
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-7000
  • Fax: 515-643-7001
Mailing address:
  • Phone: 515-643-7000
  • Fax: 515-643-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA115498
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: