Provider Demographics
NPI:1649383936
Name:TIMMONS, JANIS (ARNP)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:TIMMONS
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 1:705 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:STORY CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50248-1301
Mailing Address - Country:US
Mailing Address - Phone:515-733-5191
Mailing Address - Fax:515-733-5453
Practice Address - Street 1:1215 DUFF AVENUE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-733-5191
Practice Address - Fax:515-733-5453
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO56545363L00000X
IAA056545363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0435529Medicaid
IAI11834Medicare ID - Type Unspecified
IAQ11736Medicare UPIN