Provider Demographics
NPI:1235105669
Name:KEE, KIM DENISE (CNP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:DENISE
Last Name:KEE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2922
Mailing Address - Country:US
Mailing Address - Phone:605-996-3380
Mailing Address - Fax:
Practice Address - Street 1:1200 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2922
Practice Address - Country:US
Practice Address - Phone:605-996-3380
Practice Address - Fax:605-996-3385
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6822205Medicaid