Healthcare Provider Details

I. General information

NPI: 1417674482
Provider Name (Legal Business Name): KATIE EVELYN SHULL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 DAKOTA DUNES BLVD STE 400
DAKOTA DUNES SD
57049-5462
US

IV. Provider business mailing address

330 DAKOTA DUNES BLVD STE 400
DAKOTA DUNES SD
57049-5462
US

V. Phone/Fax

Practice location:
  • Phone: 605-422-3000
  • Fax:
Mailing address:
  • Phone: 605-422-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA163550
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA163550
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: