Healthcare Provider Details

I. General information

NPI: 1891599619
Provider Name (Legal Business Name): MEGHAN ELISE DE JONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 10/14/2026
Certification Date: 10/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N MAIN ST STE 110
MITCHELL SD
57301-2600
US

IV. Provider business mailing address

2907 S 1ST AVE
SIOUX FALLS SD
57105-4914
US

V. Phone/Fax

Practice location:
  • Phone: 605-900-0450
  • Fax: 605-900-0451
Mailing address:
  • Phone: 605-900-0450
  • Fax: 605-900-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCP003685
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR038586
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: