Healthcare Provider Details

I. General information

NPI: 1831611383
Provider Name (Legal Business Name): JESSICA MARIE KUIPERS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 S CLIFF AVE STE 100
SIOUX FALLS SD
57105-1063
US

IV. Provider business mailing address

2108 S FIRESTONE LN
SIOUX FALLS SD
57110-8510
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-8937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001231
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: