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NPI Code Detail

MEDICARE: KIMBERLY OBERLOH

MEDICARE: KIMBERLY OBERLOH
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerCP000960SD
2363L00000XNurse PractitionerCP000960SD

General Provider Information

NPI Number : 1699159186
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY OBERLOH
Provider Business Mailing Address
First Line : PO BOX 6020
Second Line :
City : RAPID CITY
State : SD
Zip : 57709-6020
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 101 E MINNESOTA ST
Second Line : SUITE 210
City : RAPID CITY
State : SD
Zip : 57701-7756
Country : US
Telephone Number : 605-342-3280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2015
Last Update Date : 03/18/2026

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Directions to “ KIMBERLY OBERLOH ” Practice Location

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