| Ikc, Llc | |
|
1701 48th St Ste 260 West Des Moines IA 50266-6726 | |
| (515) 401-4774 | |
| (515) 254-3092 |
| Full Name | Ikc, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1701 48th St Ste 260, West Des Moines, Iowa |
| Authorized Official Name and Position | Julie Otten (REVENUE CYCLE DIRECTOR) |
| Authorized Official Contact | 5157108720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ikc, Llc 1701 48th St Ste 260 West Des Moines IA 50266-6726 Ph: (515) 401-4774 | Ikc, Llc 1701 48th St Ste 260 West Des Moines IA 50266-6726 Ph: (515) 401-4774 |
| NPI Number | 1659904803 |
|---|---|
| Provider Enumeration Date | 02/17/2020 |
| Last Update Date | 10/05/2025 |
| Medicare PECOS PAC ID | 5294140851 |
|---|---|
| Medicare Enrollment ID | O20210212002431 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659904803 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Mindy K Gingery |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1124026042 PECOS PAC ID: 9931188042 Enrollment ID: I20040714000275 |
| Provider Name | Melissa A Rademacher |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1407856651 PECOS PAC ID: 7719979772 Enrollment ID: I20081023000759 |
| Provider Name | Mark L Hilliard |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1336147339 PECOS PAC ID: 4183758006 Enrollment ID: I20100813001010 |
| Provider Name | Melissa A Snyder |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1073836607 PECOS PAC ID: 0143473900 Enrollment ID: I20130104000202 |
| Provider Name | Malori J Khalil |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1629374590 PECOS PAC ID: 9931338449 Enrollment ID: I20140203001522 |
| Provider Name | Shannan N Larson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1750701009 PECOS PAC ID: 1052605805 Enrollment ID: I20160802002688 |
| Provider Name | Lacey R Cheeseman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851831499 PECOS PAC ID: 6608151196 Enrollment ID: I20170324000447 |
| Provider Name | Benjamin Blaylock |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1154708170 PECOS PAC ID: 6709156565 Enrollment ID: I20170727000192 |
| Provider Name | Jacqulyn R Griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154668135 PECOS PAC ID: 3678857943 Enrollment ID: I20180816001184 |
| Provider Name | Shawn Tulp |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1255767778 PECOS PAC ID: 3678702834 Enrollment ID: I20200630002193 |
| Provider Name | Alyssa Coughennower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346960978 PECOS PAC ID: 5092191205 Enrollment ID: I20220926001148 |
| Provider Name | Molly Anne St Clair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306611421 PECOS PAC ID: 9931552403 Enrollment ID: I20240131003396 |
| Provider Name | Courtney Mitten |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194542282 PECOS PAC ID: 2062948326 Enrollment ID: I20241210001658 |
| Provider Name | Molly Sly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093385809 PECOS PAC ID: 9830614858 Enrollment ID: I20250422002669 |
| Provider Name | Meghan Vineis |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1720511884 PECOS PAC ID: 6103343397 Enrollment ID: I20250512000662 |
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