Healthcare Provider Details

I. General information

NPI: 1265379861
Provider Name (Legal Business Name): LYNN PETERS DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 COMANCHE RD
FORT MEADE SD
57741-1002
US

IV. Provider business mailing address

50 SHERIDAN RD # 320
FORT MEADE SD
57741-9998
US

V. Phone/Fax

Practice location:
  • Phone: 605-720-7252
  • Fax:
Mailing address:
  • Phone: 605-720-7252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number431
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number46781
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: