=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043198013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOUNDSITE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2025
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 S REID ST STE 307
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57103-7045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-764-2989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 S REID ST STE 307
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57103-7045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-764-2989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | KISEAN MICHAEL PIAGET HUTSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-764-2989
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------