Healthcare Provider Details

I. General information

NPI: 1033954508
Provider Name (Legal Business Name): IOWA KETAMINE INFUSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 48TH ST STE 260
WEST DES MOINES IA
50266-6726
US

IV. Provider business mailing address

1701 48TH ST STE 260
WEST DES MOINES IA
50266-6726
US

V. Phone/Fax

Practice location:
  • Phone: 515-401-4774
  • Fax: 515-254-3092
Mailing address:
  • Phone: 515-401-4774
  • Fax: 515-254-3092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MINDY GINGERY
Title or Position: CEO
Credential: PMHNP, ARNP, CRNA
Phone: 515-988-1564