Healthcare Provider Details

I. General information

NPI: 1093209678
Provider Name (Legal Business Name): AMANDA MARIE KYTE RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 S GRAND SLAM AVE
SIOUX FALLS SD
57110-5408
US

IV. Provider business mailing address

4043 S GRAND SLAM AVE
SIOUX FALLS SD
57110-5408
US

V. Phone/Fax

Practice location:
  • Phone: 605-261-3870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: