Provider Demographics
NPI:1124026042
Name:GINGERY, MINDY KAY (PMHNP-BC, CRNA)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:KAY
Last Name:GINGERY
Suffix:
Gender:
Credentials:PMHNP-BC, CRNA
Other - Prefix:MRS
Other - First Name:MINDY
Other - Middle Name:KAY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC, CRNA
Mailing Address - Street 1:10455 NW BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2602
Mailing Address - Country:US
Mailing Address - Phone:515-988-1564
Mailing Address - Fax:
Practice Address - Street 1:1701 48TH ST STE 260
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6726
Practice Address - Country:US
Practice Address - Phone:515-348-6380
Practice Address - Fax:515-452-0565
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD093454367500000X
IAG184388363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0120741Medicaid
IA50171OtherWELLMARK GROUP #
IA0120741Medicaid
IA50171Medicare ID - Type UnspecifiedGROUP MEDICARE #