Provider Demographics
NPI:1447064928
Name:MOONSTONE MENTAL HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:MOONSTONE MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KADESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:319-853-8378
Mailing Address - Street 1:1566 S GILBERT ST UNIT 1023
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4304
Mailing Address - Country:US
Mailing Address - Phone:319-853-8378
Mailing Address - Fax:
Practice Address - Street 1:1566 S GILBERT ST UNIT 1023
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4304
Practice Address - Country:US
Practice Address - Phone:319-853-8378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty