Lakes Dermatology, PLLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

A-118055 Issued in IA

Legal business name

LAKES DERMATOLOGY, PLLC

Practice address

2704 Enterprise Ave
Spirit Lake, IA 51360

Phone

(712) 336-2728

Fax

(712) 336-2842

NPI assigned

Mar 8, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Crystal Elizabeth Meyer, ARNPNPI 1841548161

Title

Owner

Phone

(712) 336-2728

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakes Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Crystal Elizabeth Meyer, ARNP

  • Nurse Practitioner
  • Spirit Lake, IA
  • NPI 1841548161
  Medicare reassignment Care Compare group NPD Authorized official
• Stephanie Marie Newkirk, NP

  • Nurse Practitioner
  • Spirit Lake, IA
  • NPI 1427783828
  Medicare reassignment Care Compare group NPD
• Kelsey Diane Schmidt

  • Family Nurse Practitioner
  • Spirit Lake, IA
  • NPI 1366286015
  Medicare reassignment Care Compare group NPD
• Jennifer Renee Forsberg, ARNP

  • Nurse Practitioner
  • Humboldt, IA
  • NPI 1235771361
  Medicare reassignment NPD
• McKenzie Terfehr, NP

  • Nurse Practitioner
  • Fairmont, MN
  • NPI 1689284945

  IA, Single Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671580800000",
    "number": "1194186833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 ENTERPRISE AVE",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "51360",
            "telephone_number": "712-336-2728",
            "fax_number": "712-336-2842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 ENTERPRISE AVE",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "51360",
            "telephone_number": "712-336-2728",
            "fax_number": "712-336-2842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-08",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-336-2728",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A-118055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1841548161",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakes Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chandler Koehler
• Brenda Kraft, CRNA
• Lisa C Kreiter, CRNA
• Leann Elizabeth Krumwiede, PTA
• Lakes Counseling PLLC
• Lakes Family Chiropractic
• Lakes Hospice LLC
• Lakes Lifeskills LLC
• Lakes Regional Healthcare
• Lakes Regional Healthcare

• Nurse Practitioner in Spirit Lake, IA
• Providers in Spirit Lake, IA by specialty
• Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.