Healthcare Provider Details

I. General information

NPI: 1760137186
Provider Name (Legal Business Name): KRISTEN M CORKLE SOLE MBR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 KANSAS CITY ST
RAPID CITY SD
57701-3673
US

IV. Provider business mailing address

521 KANSAS CITY ST
RAPID CITY SD
57701-3673
US

V. Phone/Fax

Practice location:
  • Phone: 605-791-2500
  • Fax: 605-791-2500
Mailing address:
  • Phone: 605-791-2500
  • Fax: 605-791-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN M CORKLE
Title or Position: OWNER
Credential: CNP, FNP, PMHNP
Phone: 605-791-2500