=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326918616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIE MACK CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2025
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 N WASHINGTON ST
-----------------------------------------------------
City | VIBORG
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57070-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-326-5161
-----------------------------------------------------
Fax | 605-326-5196
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 368
-----------------------------------------------------
City | VIBORG
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57070-0368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-326-5161
-----------------------------------------------------
Fax | 605-326-5196
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CP003917
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------