MEDICARE: KAYLEE RUNGE DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CP002235	SD
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	CP002235	SD

General Provider Information

NPI Number	:	1114686011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEE RUNGE DNP

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:	605-322-8630
Fax Number	:

Provider Business Practice Location Address
First Line	:	5920 E MADISON ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-6489
Country	:	US
Telephone Number	:	605-312-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	08/05/2025

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