Provider Demographics
NPI:1265545420
Name:HAACK, CHRISTY K (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:K
Last Name:HAACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 WESTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1425
Mailing Address - Country:US
Mailing Address - Phone:515-222-8346
Mailing Address - Fax:515-222-0472
Practice Address - Street 1:2425 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1425
Practice Address - Country:US
Practice Address - Phone:515-222-8346
Practice Address - Fax:515-222-0472
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00975363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35962OtherWELLMARK
IA35449OtherMIDLANDS CHOICE
IA35449OtherMIDLANDS CHOICE