Provider Demographics
NPI:1962484287
Name:POOCK, JANA LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:LYNN
Last Name:POOCK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 NW 78TH CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1700
Mailing Address - Country:US
Mailing Address - Phone:515-276-1115
Mailing Address - Fax:
Practice Address - Street 1:1340 E HICKMAN RD
Practice Address - Street 2:SUITE D
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8137
Practice Address - Country:US
Practice Address - Phone:515-987-8833
Practice Address - Fax:515-987-3718
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00765213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6489460001OtherDMERC