Provider Demographics
NPI:1467791558
Name:MATHENY, TIFFANY NICHOLE (ARNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICHOLE
Last Name:MATHENY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2339
Mailing Address - Country:US
Mailing Address - Phone:515-266-1000
Mailing Address - Fax:515-266-1824
Practice Address - Street 1:1201 PENN AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2339
Practice Address - Country:US
Practice Address - Phone:515-266-1000
Practice Address - Fax:515-266-1824
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA108272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1467791558Medicaid
IA1467791558Medicaid