MEDICARE: KYNSIE MARINE VALDEZ

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1760313217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYNSIE MARINE VALDEZ

Provider Business Mailing Address
First Line	:	130 W QUINCY ST
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-1451
Country	:	US
Telephone Number	:	307-262-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	344 N MAIN ST STE 5
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-2436
Country	:	US
Telephone Number	:	605-644-7850
Fax Number	:

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

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “ KYNSIE MARINE VALDEZ ” Practice Location

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