Provider Demographics
NPI:1730149121
Name:HOSTERT, JODY M (ARNP)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:M
Last Name:HOSTERT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:JODY
Other - Middle Name:M
Other - Last Name:KOLB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1510 BOYSON RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2310
Mailing Address - Country:US
Mailing Address - Phone:319-396-1066
Mailing Address - Fax:319-396-8779
Practice Address - Street 1:1510 BOYSON RD
Practice Address - Street 2:ABBE MANAGEMENT CORP D/B/A ASSOCIATES FOR BEHAVIORAL HE
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2310
Practice Address - Country:US
Practice Address - Phone:319-396-1066
Practice Address - Fax:319-396-8779
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG097506363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0443945Medicaid
IA0443945Medicaid
IAI13265Medicare ID - Type Unspecified