MEDICARE: MS. KATHRYN JANE HALSTEAD MSTOM

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
1	171100000X	Acupuncturist		SD

General Provider Information

NPI Number	:	1497828081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN JANE HALSTEAD MSTOM

Provider Business Mailing Address
First Line	:	7904 PATHFINDER PL
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-9135
Country	:	US
Telephone Number	:	605-721-4580
Fax Number	:	605-721-3944

Provider Business Practice Location Address
First Line	:	2416 JACKSON BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3450
Country	:	US
Telephone Number	:	605-721-4580
Fax Number	:	605-721-4580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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