Healthcare Provider Details

I. General information

NPI: 1780407270
Provider Name (Legal Business Name): CARRIE KOCER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 SOUTH MAIN STREET
MISSION SD
57555
US

IV. Provider business mailing address

161 S MAIN ST
MISSION SD
57555
US

V. Phone/Fax

Practice location:
  • Phone: 605-856-2295
  • Fax:
Mailing address:
  • Phone: 605-856-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP003435
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: