Provider Demographics
NPI:1124026042
Name:GINGERY, MINDY KAY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:KAY
Last Name:GINGERY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:MINDY
Other - Middle Name:KAY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:8736 NW 27TH CT
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7916
Mailing Address - Country:US
Mailing Address - Phone:515-988-1564
Mailing Address - Fax:
Practice Address - Street 1:8736 NW 27TH CT
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7916
Practice Address - Country:US
Practice Address - Phone:515-988-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD093454367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0120741Medicaid
IA50171OtherWELLMARK GROUP #
IA0120741Medicaid
IA50171Medicare ID - Type UnspecifiedGROUP MEDICARE #