Provider Demographics
NPI:1275834012
Name:KAPUSTKA, JODY L (ARNP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:KAPUSTKA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:KAPUSTKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2521 UNIVERSITY BLVD STE 121
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8629
Mailing Address - Country:US
Mailing Address - Phone:515-292-2150
Mailing Address - Fax:515-292-2184
Practice Address - Street 1:1111 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5745
Practice Address - Country:US
Practice Address - Phone:515-239-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG-102777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG-102777OtherLICENSE