Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 363AM0700X | Physician Assistant | Medical | 001458 | IOWA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 66046 | OTHER | IOWA | BCBS SNF |
| 2 | 0283465 | MEDICAID | IOWA | |
| 3 | 60046 | OTHER | IOWA | BCBS REG |
| 4 | 29352 | MEDICARE ID-TYPE UNSPECIFIED | IOWA | HOSPITAL MEDICARE PART B |
| 5 | 0424507 | MEDICAID | IOWA | |
| 6 | P31683 | MEDICARE UPIN | IOWA | |
| 7 | 0635011 | MEDICAID | IOWA | |
| 8 | 0600460 | MEDICAID | IOWA | |
| 9 | 0293522 | MEDICAID | IOWA | |
| 10 | 36174 | OTHER | IOWA | BCBS DME |
| 11 | 33444 | OTHER | IOWA | FPC BCBS NRH |
| 12 | DA1838 | MEDICARE ID-TYPE UNSPECIFIED | IOWA | FPC MEDICARE RR |
| 13 | 0655001 | MEDICAID | IOWA | |
| 14 | 0381980001 | MEDICARE NSC | IOWA | |
| 15 | 29352 | OTHER | IOWA | BCBS ER |
| 16 | 163495 | MEDICARE ID-TYPE UNSPECIFIED | IOWA | FPC MEDICARE |
| 17 | 16Z302 | MEDICARE OSCAR/CERTIFICATION | IOWA | |
| 18 | CE8231 | MEDICARE OSCAR/CERTIFICATION | IOWA | |
| 19 | 161302 | MEDICARE OSCAR/CERTIFICATION | IOWA | |
