Provider Demographics
NPI:1033551114
Name:ZIMMER, KARISSA G (PA-C)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:G
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:G
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2315 W. 57TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108
Mailing Address - Country:US
Mailing Address - Phone:615-271-5441
Mailing Address - Fax:605-271-5277
Practice Address - Street 1:2315 W. 57TH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:615-271-5441
Practice Address - Fax:605-271-5277
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0876363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1033551114Medicaid