MEDICARE: AUDREY JEAN FUKS PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CP002406	SD

General Provider Information

NPI Number	:	1538807581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY JEAN FUKS PMHNP

Provider Business Mailing Address
First Line	:	3803 W TECHNOLOGY CIR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4233
Country	:	US
Telephone Number	:	605-702-4409
Fax Number	:

Provider Business Practice Location Address
First Line	:	3803 W TECHNOLOGY CIR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4233
Country	:	US
Telephone Number	:	605-702-4409
Fax Number	:	605-309-7914

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

Provider Enumeration Date	:	05/20/2022
Last Update Date	:	04/09/2026

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