Healthcare Provider Details

I. General information

NPI: 1982246187
Provider Name (Legal Business Name): REBECCA MCCASKELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 4TH ST SE
HURON SD
57350-2510
US

IV. Provider business mailing address

1844 MCCLELLAN DR
HURON SD
57350-3825
US

V. Phone/Fax

Practice location:
  • Phone: 605-353-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001653
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: