Provider Demographics
NPI:1013107580
Name:TRUCKENMILLER, TANYA L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:L
Last Name:TRUCKENMILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:L
Other - Last Name:KLEINSCHMIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5126
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5126
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:911 E 20TH ST STE 505
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1047
Practice Address - Country:US
Practice Address - Phone:605-322-7250
Practice Address - Fax:605-322-7251
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1335363A00000X
SD0687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00700560OtherRAILROAD MEDICARE
SD6830640Medicaid
SDP00700560OtherRAILROAD MEDICARE