Healthcare Provider Details

I. General information

NPI: 1487293692
Provider Name (Legal Business Name): KATHERINE LYFORD WILGERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE LYFORD COREY CNP

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W MAIN ST STE 210
RAPID CITY SD
57702-2439
US

IV. Provider business mailing address

115 N 7TH ST STE 6
SPEARFISH SD
57783-2710
US

V. Phone/Fax

Practice location:
  • Phone: 605-645-0100
  • Fax: 605-717-1009
Mailing address:
  • Phone: 605-645-0100
  • Fax: 605-717-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCP001757
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: