Healthcare Provider Details

I. General information

NPI: 1295655736
Provider Name (Legal Business Name): KASSIDY GRABER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSIDY SOMA

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W 17TH ST STE 102
SIOUX FALLS SD
57104-8805
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-312-3250
  • Fax:
Mailing address:
  • Phone: 605-328-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1734
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: