Individual provider Active NPI

Jessica Leigh Van Dyke, ARNP

  • Nurse Practitioner
  • Waterloo, IA
National Provider Identifier
1902638620
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A180891 Issued in IA
Practice address
419 E Donald St
Waterloo, IA 50703-1500
Phone
(319) 236-1911
NPI assigned
Aug 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X A180891 IA Primary

Addresses

Primary practice location

419 E Donald St
Waterloo, IA 50703-1500

Mailing address

PO Box 2758
Waterloo, IA 50704-2758
Phone (319) 235-5390

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
I20240913003290 IA Practitioner - Nurse Practitioner 7810437076 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1000 Brandilynn Blvd
Cedar Falls, IA 50613-7462

1655 E San Marnan Dr
Suite H
Waterloo, IA 50702-4378
Phone (319) 232-2281

2160 Logan Ave
Waterloo, IA 50703-1006
Phone (319) 226-5860

4480 Utica Ridge Rd
Bettendorf, IA 52722-1644

4480 Utica Ridge Rd
Suite 160
Bettendorf, IA 52722-1637
Phone (563) 742-5950

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A180891IAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation CurrentSince May 19, 2025 Accepting new patients
Cedar Valley Medical Specialists PC PastSince Oct 23, 2022 Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

1600 1st St E
Independence, IA 50644
Phone (319) 332-0999

201 8th Ave SE
Oelwein, IA 50662
Phone (319) 283-4321

419 E Donald St
Waterloo, IA 50703
Phone (319) 888-7604

1753 W Ridgeway Ave
Ste 107
Waterloo, IA 50701
Phone (319) 833-5907

312 9th St SW
Ste 3400
Waverly, IA 50677
Phone (319) 483-4029

Interoperability endpoints

  • Direct secure messaging: jvandyke1047252@direct.unitypoint.org

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1902638620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2758",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507042758",
            "telephone_number": "319-235-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 E DONALD ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031500",
            "telephone_number": "319-236-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYKE",
        "first_name": "JESSICA",
        "middle_name": "LEIGH",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A180891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.