Individual provider Active NPI

Mikayla R Siddell, ARNP

  • Pediatric Nurse Practitioner
  • Coralville, IA
National Provider Identifier
1306711619
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
C187445 Issued in IA
Practice address
2769 Heartland Dr Ste 100
Coralville, IA 52241-2732
Phone
(319) 688-7337
Fax
(319) 688-7701
NPI assigned
Oct 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X C187445 IA Primary

Addresses

Primary practice location

2769 Heartland Dr Ste 100
Coralville, IA 52241-2732

Mailing address

200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 384-7222

Other practice location 1

200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 384-7222

Other names 1

  • Mikayla Long Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251114000400 IA Practitioner - Nurse Practitioner 4789175043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

200 Hawkins Dr
Iowa City, IA 52242-1007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
C187445IAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
State University of Iowa CurrentSince Nov 5, 2025 Accepting new patients
State University of Iowa Past Accepting new patients

Locations

2769 Heartland Dr
Ste 100
Coralville, IA 52241
Phone (319) 339-3597

200 Hawkins Dr
#H
Iowa City, IA 52242
Phone (319) 356-1616

200 Hawkins Dr
Iowa City, IA 52242
Phone (319) 356-1616

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1759795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1306711619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-384-7222",
            "fax_number": "319-356-3949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2769 HEARTLAND DR STE 100",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412732",
            "telephone_number": "319-688-7337",
            "fax_number": "319-688-7701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawkins Dr",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522421009",
            "country_code": "US",
            "telephone_number": "319-384-7222",
            "fax_number": "319-356-3949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDDELL",
        "first_name": "MIKAYLA",
        "middle_name": "R",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-07",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IA",
            "license": "C187445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIKAYLA",
            "last_name": "LONG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Coralville, IA

Sources for this page

Verify at the official NPI Registry.