Provider Demographics
NPI:1750914677
Name:HENDRICKS, KATHERINE (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KASIE
Other - Middle Name:
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1509 7TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-5706
Mailing Address - Country:US
Mailing Address - Phone:605-237-3717
Mailing Address - Fax:
Practice Address - Street 1:1056 29TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9120
Practice Address - Country:US
Practice Address - Phone:605-753-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily