Provider Demographics
NPI:1649943689
Name:COFFEY, JESSICA LEEANNE (ARNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEEANNE
Last Name:COFFEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEEANNE
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:6800 LAKE DR STE 285
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2544
Mailing Address - Country:US
Mailing Address - Phone:515-697-0179
Mailing Address - Fax:
Practice Address - Street 1:1005 BLAIRS FERRY RD NE STE 30
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1219
Practice Address - Country:US
Practice Address - Phone:515-226-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA164840363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner