Healthcare Provider Details

I. General information

NPI: 1710696919
Provider Name (Legal Business Name): SHJADE CAROLINA SMITH APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHJADE HEUTZENROEDER

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAPLE ST
TEA SD
57064-2300
US

IV. Provider business mailing address

2333 W 57TH ST STE 103
SIOUX FALLS SD
57108-5054
US

V. Phone/Fax

Practice location:
  • Phone: 605-261-4103
  • Fax:
Mailing address:
  • Phone: 605-271-5640
  • Fax: 605-653-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10387
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCP002571
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: