Provider Demographics
NPI:1821664012
Name:ISAACSON, KEILIN (ARNP)
Entity Type:Individual
Prefix:
First Name:KEILIN
Middle Name:
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KEILIN
Other - Middle Name:
Other - Last Name:BENNETT WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4020 MERLE HAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1357
Mailing Address - Country:US
Mailing Address - Phone:515-278-0949
Mailing Address - Fax:
Practice Address - Street 1:4020 MERLE HAY RD STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1357
Practice Address - Country:US
Practice Address - Phone:515-278-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA163627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner