Healthcare Provider Details

I. General information

NPI: 1750865192
Provider Name (Legal Business Name): KELSEY MARIE HUPP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY MARIE RICHTER RN

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LN
PIERRE SD
57501-3391
US

IV. Provider business mailing address

112 BULOW DR
PIERRE SD
57501-3806
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5901
  • Fax:
Mailing address:
  • Phone: 605-515-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001443
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: