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General NPI Number Information
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NPI Number | 1962648287
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Entity Type | Organization
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Legal Business Name | PRAIRIE FAMILY HEALTHCARE, P.C.
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 1115 E 5TH AVE
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City | MITCHELL
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State | SD
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Zip | 57301-2917
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Country | US
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Telephone | 605-996-5553
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Fax | 605-996-1213
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Provider Business Mailing Address
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Address Line | 1115 E 5TH AVE
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City | MITCHELL
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State | SD
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Zip | 57301-2917
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Country | US
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Telephone | 605-996-5553
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Fax | 605-996-1213
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANE LYNN KENKEL
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Credential | CNP
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Telephone | 605-996-5553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CP000190
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License Number State | SD
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