Provider Demographics
NPI:1063243426
Name:MENNINGA, JODI L (DNP, ARNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:MENNINGA
Suffix:
Gender:F
Credentials:DNP, ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1597
Mailing Address - Country:US
Mailing Address - Phone:515-282-2200
Mailing Address - Fax:
Practice Address - Street 1:1914 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1309
Practice Address - Country:US
Practice Address - Phone:515-282-5742
Practice Address - Fax:515-282-5744
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG180671363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health