Provider Demographics
NPI:1154320547
Name:DEAN, KATHRYN R (CNM)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:R
Last Name:DEAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:WESSINGTON SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57382-2134
Mailing Address - Country:US
Mailing Address - Phone:605-539-1778
Mailing Address - Fax:605-539-9546
Practice Address - Street 1:602 1ST ST NE
Practice Address - Street 2:
Practice Address - City:WESSINGTON SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57382-2134
Practice Address - Country:US
Practice Address - Phone:605-539-1778
Practice Address - Fax:605-539-9546
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0005367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0005OtherSTATE LICENSE
SD0005OtherSTATE LICENSE
5627Medicare ID - Type Unspecified