Healthcare Provider Details

I. General information

NPI: 1457135014
Provider Name (Legal Business Name): BOBBY JO HAMM REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SD HIGHWAY 10 STE C
SISSETON SD
57262-2527
US

IV. Provider business mailing address

1820 SD HIGHWAY 10
SISSETON SD
57262-2526
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-4363
  • Fax: 605-698-4367
Mailing address:
  • Phone: 605-698-4363
  • Fax: 605-698-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRO32738
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: