Healthcare Provider Details

I. General information

NPI: 1285358564
Provider Name (Legal Business Name): BRIDGES PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 OFFICE PARK RD STE 310
WEST DES MOINES IA
50265-2538
US

IV. Provider business mailing address

939 OFFICE PARK RD STE 310
WEST DES MOINES IA
50265-2538
US

V. Phone/Fax

Practice location:
  • Phone: 515-771-7852
  • Fax:
Mailing address:
  • Phone: 515-771-7852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MELLY
Title or Position: ARNP, PMHNP
Credential:
Phone: 515-771-7852