Provider Demographics
NPI:1487397733
Name:HERKELMAN, CARISSA ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:ELIZABETH
Last Name:HERKELMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 NAPOLI AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-4216
Mailing Address - Country:US
Mailing Address - Phone:616-252-7200
Mailing Address - Fax:616-252-4953
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2613
Practice Address - Country:US
Practice Address - Phone:616-252-7200
Practice Address - Fax:616-252-4953
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA06880207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program