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General NPI Number Information
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NPI Number | 1750001970
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Entity Type | Individual
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Provider Name | KENZIE SUZETTE GANT DNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 111 WASHINGTON AVE NW
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City | WAGNER
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State | SD
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Zip | 57380-4300
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Country | US
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Telephone | 605-384-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 610 MAIN AVE
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City | GEDDES
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State | SD
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Zip | 57342-2206
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Country | US
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Telephone | 605-212-8495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | CP002187
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CP002187
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License Number State | SD
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