Healthcare Provider Details

I. General information

NPI: 1699404814
Provider Name (Legal Business Name): MORGAN LYNN MOELTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 69TH ST
SIOUX FALLS SD
57108-8170
US

IV. Provider business mailing address

808 S PARKVIEW BLVD
BRANDON SD
57005-1937
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-4005
  • Fax:
Mailing address:
  • Phone: 605-731-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1726
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3020
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: