Healthcare Provider Details

I. General information

NPI: 1013567627
Provider Name (Legal Business Name): KASANDRA WHEELER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W 17TH ST STE 1
SIOUX FALLS SD
57104-4663
US

IV. Provider business mailing address

5508 PARK KNL
SIOUX FALLS SD
57108-5216
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001637
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: