Healthcare Provider Details

I. General information

NPI: 1982070058
Provider Name (Legal Business Name): MOLLY HEIDEN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 UNIVERSITY AVE STE 105
WEST DES MOINES IA
50266-7756
US

IV. Provider business mailing address

PO BOX 424
DES MOINES IA
50302-0424
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9070
  • Fax:
Mailing address:
  • Phone: 515-875-9925
  • Fax: 515-875-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number101678
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3613-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: