Healthcare Provider Details

I. General information

NPI: 1255573408
Provider Name (Legal Business Name): ANDREW THOMAS KAPPENMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S SANTA FE AVE SUITE 260
SALINA KS
67401-4190
US

IV. Provider business mailing address

100 SETH ST
BRANDON SD
57005-2530
US

V. Phone/Fax

Practice location:
  • Phone: 785-827-2230
  • Fax:
Mailing address:
  • Phone: 605-929-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR031721
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: