Provider Demographics
NPI:1861778508
Name:PIFKIN, JESSICA ELLEN (ARNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELLEN
Last Name:PIFKIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ELLEN
Other - Last Name:MOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2140 LOGAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1002
Mailing Address - Country:US
Mailing Address - Phone:319-226-8470
Mailing Address - Fax:319-226-8475
Practice Address - Street 1:2140 LOGAN AVE STE B
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1002
Practice Address - Country:US
Practice Address - Phone:319-226-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-116473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1861778502Medicaid