Provider Demographics
NPI:1669626396
Name:MRACEK-KNIGHT, KARLA A (LISW, RD)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:A
Last Name:MRACEK-KNIGHT
Suffix:
Gender:F
Credentials:LISW, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 29TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5824
Mailing Address - Country:US
Mailing Address - Phone:563-380-4118
Mailing Address - Fax:
Practice Address - Street 1:400 E COURT AVE STE 236
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2023
Practice Address - Country:US
Practice Address - Phone:515-650-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001841133V00000X
IA0829631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923138Medicare PIN