Healthcare Provider Details

I. General information

NPI: 1114860277
Provider Name (Legal Business Name): KACY PETERSON DCLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CLIFF AVE
SIOUX FALLS SD
57105-1005
US

IV. Provider business mailing address

2817 E SUNFLOWER CIR
BRANDON SD
57005-6709
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-7068
  • Fax:
Mailing address:
  • Phone: 605-350-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: