Provider Demographics
NPI:1295080364
Name:FREDERICK, RACHEL LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:GRIMSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:642 XAVIER PL
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-2676
Mailing Address - Country:US
Mailing Address - Phone:515-686-9231
Mailing Address - Fax:
Practice Address - Street 1:2610 NORTHRIDGE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4088
Practice Address - Country:US
Practice Address - Phone:515-789-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA002308OtherIOWA LICENSE