Provider Demographics
NPI:1730841404
Name:HESSELTINE, JOHANNA (PMHNP)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:HESSELTINE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 NW 138TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8300
Mailing Address - Country:US
Mailing Address - Phone:515-758-8300
Mailing Address - Fax:515-758-8500
Practice Address - Street 1:1350 NW 138TH ST STE 200
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8300
Practice Address - Country:US
Practice Address - Phone:515-360-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG166037363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health