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Specialty details in registry · Council Bluffs, IA

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At a glance

40 Northcrest Dr Ste 1, Council Bluffs, IA 51503-1698

NPPES record updated Aug 15, 2025. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

40 Northcrest Dr Ste 1
Council Bluffs, IA 51503-1698

Professional details: NPI, taxonomy & registry record

NPI1194601864

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 1223P0221X
Enumeration date: Aug 15, 2025
Record updated: Aug 15, 2025

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

1223P0221X · Primary

Specialty details in registry

1223X0400X

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

40 Northcrest Dr Ste 1
Council Bluffs, IA 51503-1698

Phone: (712) 328-9605

Mailing address

1610 54TH AVE N STE 205

NASHVILLE, TN 372091442

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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