Provider Demographics
NPI:1114686011
Name:RUNGE, KAYLEE (DNP)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:RUNGE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 S LOUISE AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6030
Mailing Address - Country:US
Mailing Address - Phone:605-322-8630
Mailing Address - Fax:
Practice Address - Street 1:6100 S LOUISE AVE STE 1100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6030
Practice Address - Country:US
Practice Address - Phone:605-322-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily