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NPI Code Detail

MEDICARE: KELLY RENAE BIRKLA

MEDICARE:   KELLY RENAE BIRKLA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WE0003XEmergency Registered NurseR043115SD

General Provider Information

NPI Number : 1366330813
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RENAE BIRKLA
Provider Business Mailing Address
First Line : 1117 11TH AVE NE
Second Line :
City : ABERDEEN
State : SD
Zip : 57401-2232
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1117 11TH AVE NE
Second Line :
City : ABERDEEN
State : SD
Zip : 57401-2232
Country : US
Telephone Number : 605-216-3343
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2025
Last Update Date : 06/25/2025

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Directions to “ KELLY RENAE BIRKLA ” Practice Location

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