Provider Demographics
NPI:1891788485
Name:VISTA-WAYNE, JOYCE A (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:VISTA-WAYNE
Suffix:
Gender:F
Credentials:MD
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-9030
Mailing Address - Fax:515-643-9031
Practice Address - Street 1:6601 SW 9TH ST STE 2
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-6138
Practice Address - Country:US
Practice Address - Phone:515-643-9030
Practice Address - Fax:515-643-9031
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA323482084P0800X, 2084P0804X
IAMD-323482084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42068106058OtherJOHN DEERE HEALTH
IA46078OtherWELLMARK, INC BCBS
IA0168526Medicaid
IA42068106058OtherUNITED BEHAVIORAL HEALTH
IAT005OtherTRIWEST
IA145827OtherIOWA HEALTH SOLUTIONS
IAI6790Medicare PIN
IA145827OtherIOWA HEALTH SOLUTIONS
F90096Medicare UPIN
IA46078OtherWELLMARK, INC BCBS