Healthcare Provider Details

I. General information

NPI: 1619639150
Provider Name (Legal Business Name): JOEL KIRST NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 CAREGIVER CIR
RAPID CITY SD
57702-8529
US

IV. Provider business mailing address

312 E LIBERTY ST
RAPID CITY SD
57701-7669
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-6100
  • Fax:
Mailing address:
  • Phone: 605-786-7076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberCP002171
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP002171
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: