Provider Demographics
NPI:1891194320
Name:APPLEGATE, CASSIE (CNM)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 W SAINT ANNE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4271
Mailing Address - Country:US
Mailing Address - Phone:605-858-1269
Mailing Address - Fax:
Practice Address - Street 1:6015 MOUNT RUSHMORE RD STE 2
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8962
Practice Address - Country:US
Practice Address - Phone:605-343-9224
Practice Address - Fax:605-342-1359
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0195978176B00000X
SDCM000066367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6540890Medicaid