Healthcare Provider Details

I. General information

NPI: 1467113738
Provider Name (Legal Business Name): MEGGAN CRISP BSN, RN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGGAN VIOLA KOWALSKI BSN, RN

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W 17TH ST STE 101
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: 605-237-8449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP002291
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07210098
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: