Provider Demographics
NPI:1336731108
Name:DYER, KATE ELLEN (CNP)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:ELLEN
Last Name:DYER
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 1:2820 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5474
Mailing Address - Country:US
Mailing Address - Phone:605-545-3879
Mailing Address - Fax:605-721-8445
Practice Address - Street 1:2820 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5474
Practice Address - Country:US
Practice Address - Phone:605-388-5590
Practice Address - Fax:605-721-8445
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner