Healthcare Provider Details

I. General information

NPI: 1659904803
Provider Name (Legal Business Name): IKC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
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 TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE OTTEN
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 515-710-8720