Healthcare Provider Details

I. General information

NPI: 1891350351
Provider Name (Legal Business Name): KESLEY CARPENTER PIKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 09/08/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 22ND ST
SIOUX FALLS SD
57105-1554
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 605-322-5737
  • Fax:
Mailing address:
  • Phone: 602-692-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPT18849
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: