Healthcare Provider Details

I. General information

NPI: 1598205338
Provider Name (Legal Business Name): TARYN MARTIN APRN, FNP-C, ATC,LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 8TH AVE NE
ABERDEEN SD
57401-3242
US

IV. Provider business mailing address

2120 8TH AVE NE
ABERDEEN SD
57401-3242
US

V. Phone/Fax

Practice location:
  • Phone: 605-725-4772
  • Fax:
Mailing address:
  • Phone: 605-725-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR48736
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP002240
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0365
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number430-11
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: