Provider Demographics
NPI:1609447309
Name:KNUTSON, RILEY JACOB (PA)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:JACOB
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 S DUNDEE DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4922
Mailing Address - Country:US
Mailing Address - Phone:605-660-8997
Mailing Address - Fax:
Practice Address - Street 1:911 E 20TH ST STE 700
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1049
Practice Address - Country:US
Practice Address - Phone:605-334-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant