Provider Demographics
NPI:1114451689
Name:HOCKHAUSEN, KIRSTIN ASHLEY
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:ASHLEY
Last Name:HOCKHAUSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIRSTIN
Other - Middle Name:ASHLEY
Other - Last Name:HUOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3020 STOCKADE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-5250
Mailing Address - Country:US
Mailing Address - Phone:605-484-8895
Mailing Address - Fax:
Practice Address - Street 1:2805 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6003
Practice Address - Country:US
Practice Address - Phone:605-755-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SD12850207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program