Healthcare Provider Details

I. General information

NPI: 1144903097
Provider Name (Legal Business Name): LUNA MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 VALLEY WEST DR STE 503
WEST DES MOINES IA
50266-1906
US

IV. Provider business mailing address

3086 COTTONWOOD DR
WAUKEE IA
50263-8021
US

V. Phone/Fax

Practice location:
  • Phone: 515-468-3639
  • Fax:
Mailing address:
  • Phone: 515-468-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KERRI LEIGH PATTON
Title or Position: ARNP
Credential: NP
Phone: 515-468-3639