Provider Demographics
NPI:1326550922
Name:DEAN, KATIE M (PNP-AC, PC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:DEAN
Suffix:
Gender:
Credentials:PNP-AC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-7977
Mailing Address - Fax:
Practice Address - Street 1:5005 DOUGLAS AVE STE 101
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2760
Practice Address - Country:US
Practice Address - Phone:515-724-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-04
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117312163WP0200X
IAC117312363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics