Provider Demographics
NPI:1053682997
Name:HARTMANN MCSHERRY, JODIE KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:KATHERINE
Last Name:HARTMANN MCSHERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:2400 S MINNESOTA AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1417 S. CLIFF AVE.
Practice Address - Street 2:STE. 300
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1062
Practice Address - Country:US
Practice Address - Phone:605-322-8630
Practice Address - Fax:605-322-8631
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2014-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD0797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6836980Medicaid
SDS105728Medicare PIN