Provider Demographics
NPI:1013343284
Name:NEVINS, KATHRYN L (CNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:NEVINS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:NEVINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:400 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2497
Mailing Address - Country:US
Mailing Address - Phone:605-697-5000
Mailing Address - Fax:605-697-6939
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000815363LF0000X
MNCNP5242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily