Healthcare Provider Details

I. General information

NPI: 1578054250
Provider Name (Legal Business Name): KATHY JEAN JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S SUMMIT AVE
SIOUX FALLS SD
57105-2727
US

IV. Provider business mailing address

2000 S SUMMIT AVE
SIOUX FALLS SD
57105-2727
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-2467
  • Fax: 605-275-6541
Mailing address:
  • Phone: 605-271-2467
  • Fax: 605-275-6541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR041743
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: