Provider Demographics
NPI:1760137186
Name:KRISTEN M CORKLE SOLE MBR
Entity Type:Organization
Organization Name:KRISTEN M CORKLE SOLE MBR
Other - Org Name:BLACK HILLS MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORKLE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP, FNP, PMHNP
Authorized Official - Phone:605-791-2500
Mailing Address - Street 1:521 KANSAS CITY ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3673
Mailing Address - Country:US
Mailing Address - Phone:605-791-2500
Mailing Address - Fax:605-791-2500
Practice Address - Street 1:521 KANSAS CITY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3673
Practice Address - Country:US
Practice Address - Phone:605-791-2500
Practice Address - Fax:605-791-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty