Provider Demographics
NPI:1750001970
Name:GANT, KENZIE SUZETTE (DNP, FNP)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:SUZETTE
Last Name:GANT
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GEDDES
Mailing Address - State:SD
Mailing Address - Zip Code:57342-2206
Mailing Address - Country:US
Mailing Address - Phone:605-212-8495
Mailing Address - Fax:
Practice Address - Street 1:111 WASHINGTON AVE NW
Practice Address - Street 2:
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380-4300
Practice Address - Country:US
Practice Address - Phone:605-384-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002187363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care