Provider Demographics
NPI:1891746988
Name:LIVESAY, JODY L (ARNP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:LIVESAY
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 1:918 W PLATT ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2038
Mailing Address - Country:US
Mailing Address - Phone:563-652-5145
Mailing Address - Fax:563-652-3674
Practice Address - Street 1:918 W PLATT ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2038
Practice Address - Country:US
Practice Address - Phone:563-652-5145
Practice Address - Fax:563-652-3674
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-090003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
075902OtherHEALTH ALLIANCE
236964OtherMIDLANDS CHOICE
IA1266429Medicaid
IA34151OtherWELLMARK BC/BS-CLINTON
IA01C4OtherJOHN DEERE HEALTH
IA34150OtherWELLMARK BC/BS-DEWITT
IA1266429Medicaid
236964OtherMIDLANDS CHOICE
ILP00397119Medicare PIN
IAI9753Medicare PIN
P68327Medicare UPIN
IL202842Medicare PIN