Provider Demographics
NPI:1659331361
Name:MEYER, NICOLE LYNETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNETTE
Last Name:MEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:5950 UNIVERSITY AVE
Practice Address - Street 2:STE 205
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-875-9290
Practice Address - Fax:515-875-9291
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS60909Medicare UPIN
IAI18038Medicare PIN
IA970019863Medicare PIN