Healthcare Provider Details

I. General information

NPI: 1336764182
Provider Name (Legal Business Name): STACY KUIPER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
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

7147 VISTA DR STE 150
WEST DES MOINES IA
50266-9317
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA158964
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA158964
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: