Provider Demographics
NPI:1700020203
Name:KEONIN, LINDSEY J (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:J
Last Name:KEONIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:J
Other - Last Name:HUGG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4557
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-4557
Mailing Address - Country:US
Mailing Address - Phone:866-290-4325
Mailing Address - Fax:515-280-9525
Practice Address - Street 1:2304 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-4316
Practice Address - Country:US
Practice Address - Phone:866-290-4325
Practice Address - Fax:515-280-9525
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA110681363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0057570Medicaid
IAI0623OtherMEDICARE ID
IAI0623OtherMEDICARE ID
IA0057570Medicaid