Provider Demographics
NPI:1417674482
Name:SHULL, KATIE EVELYN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:EVELYN
Last Name:SHULL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 DAKOTA DUNES BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5462
Mailing Address - Country:US
Mailing Address - Phone:605-422-3000
Mailing Address - Fax:
Practice Address - Street 1:330 DAKOTA DUNES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5462
Practice Address - Country:US
Practice Address - Phone:605-422-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA163550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner