Healthcare Provider Details

I. General information

NPI: 1003581141
Provider Name (Legal Business Name): BRITTNEY MICHELE KORTHALS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 JACKSON ST
BURKE SD
57523-2065
US

IV. Provider business mailing address

809 JACKSON ST
BURKE SD
57523-2065
US

V. Phone/Fax

Practice location:
  • Phone: 605-775-2621
  • Fax:
Mailing address:
  • Phone: 605-775-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP002102
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: