Healthcare Provider Details

I. General information

NPI: 1275293151
Provider Name (Legal Business Name): JEREMY W TAMISIEA MSN, APRN, NP-C, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

5228 S WOODSEDGE TRL
SIOUX FALLS SD
57108-8452
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-4065
  • Fax: 695-322-4060
Mailing address:
  • Phone: 160-532-1804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP002305
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR039978
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: