Healthcare Provider Details

I. General information

NPI: 1346246493
Provider Name (Legal Business Name): KASEY J HANSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BYRON BLVD
CHAMBERLAIN SD
57325-9741
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-337-3364
  • Fax: 605-337-3360
Mailing address:
  • Phone:
  • Fax: 605-337-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR028987
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: