Healthcare Provider Details

I. General information

NPI: 1881496511
Provider Name (Legal Business Name): DAKOTA ROOTS HEALTH CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 S MAIN ST
ABERDEEN SD
57401-7071
US

IV. Provider business mailing address

1206 S MAIN ST
ABERDEEN SD
57401-7071
US

V. Phone/Fax

Practice location:
  • Phone: 605-982-5063
  • Fax: 605-982-5072
Mailing address:
  • Phone: 605-982-5063
  • Fax: 605-982-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY DAWN PETERSON
Title or Position: MEDICAL DIRECTOR
Credential: CNP
Phone: 605-982-5063