Provider Demographics
NPI:1376858886
Name:KAST, JESSECA LYNN (CNP)
Entity Type:Individual
Prefix:
First Name:JESSECA
Middle Name:LYNN
Last Name:KAST
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:PO BOX 100
Mailing Address - Street 2:1300 OAK ST.
Mailing Address - City:FAULKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57438-0100
Mailing Address - Country:US
Mailing Address - Phone:605-598-6262
Mailing Address - Fax:
Practice Address - Street 1:1300 OAK ST.
Practice Address - Street 2:
Practice Address - City:FAULKTON
Practice Address - State:SD
Practice Address - Zip Code:57438-0100
Practice Address - Country:US
Practice Address - Phone:605-598-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily