MEDICARE: KRISTI OWEN CNP

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	207RG0100X	Gastroenterology Physician	CP002901	SD

General Provider Information

NPI Number	:	1851072243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI OWEN CNP

Provider Business Mailing Address
First Line	:	1415 N POPLAR AVE
Second Line	:
City	:	TEA
State	:	SD
Zip	:	57064-2570
Country	:	US
Telephone Number	:	605-759-0285
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 S LOUISE AVE STE 3100
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-6032
Country	:	US
Telephone Number	:	605-322-8630
Fax Number	:

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

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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