Provider Demographics
NPI:1003886839
Name:ZEPP, KAREN KAY (PA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KAY
Last Name:ZEPP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 MEADE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5103
Mailing Address - Country:US
Mailing Address - Phone:605-341-5910
Mailing Address - Fax:605-341-9052
Practice Address - Street 1:717 MEADE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5103
Practice Address - Country:US
Practice Address - Phone:605-341-5910
Practice Address - Fax:605-341-9052
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0599363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6828100Medicaid
SD4994397OtherBLUE CROSS BLUE SHIELD
SDP00252722Medicare PIN
SD4994397OtherBLUE CROSS BLUE SHIELD
SD6828100Medicaid