Provider Demographics
NPI:1952549701
Name:REIMANN-DORIS, KYRSTIN LEE (PA)
Entity Type:Individual
Prefix:
First Name:KYRSTIN
Middle Name:LEE
Last Name:REIMANN-DORIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 GALL STREET
Mailing Address - Street 2:
Mailing Address - City:LOWER BRULE
Mailing Address - State:SD
Mailing Address - Zip Code:57548
Mailing Address - Country:US
Mailing Address - Phone:605-473-5526
Mailing Address - Fax:605-473-0607
Practice Address - Street 1:601 GALL STREET
Practice Address - Street 2:
Practice Address - City:LOWER BRULE
Practice Address - State:SD
Practice Address - Zip Code:57548
Practice Address - Country:US
Practice Address - Phone:605-473-5526
Practice Address - Fax:605-473-5677
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant