Provider Demographics
NPI:1053783175
Name:ROUSSEAU, KATHLEEN (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 N ANKENY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4003
Mailing Address - Country:US
Mailing Address - Phone:515-964-4600
Mailing Address - Fax:515-963-4142
Practice Address - Street 1:1105 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4003
Practice Address - Country:US
Practice Address - Phone:515-964-4600
Practice Address - Fax:515-963-4142
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG176301363LP0808X
IAA108463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health