Provider Demographics
NPI:1619416526
Name:KLIMISCH, AMELIA JO (CNP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:JO
Last Name:KLIMISCH
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 1:2001 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2032
Mailing Address - Country:US
Mailing Address - Phone:605-661-5242
Mailing Address - Fax:
Practice Address - Street 1:725 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1229
Practice Address - Country:US
Practice Address - Phone:605-661-5242
Practice Address - Fax:877-345-3501
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily