Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 9251 | SD |
NPI | 1003103664 |
---|---|
Provider Name | Kimberly Kennedy |
First Address | Rapid City, SD 57709-6020 |
Second Address | Rapid City, SD 57701-7756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 05/08/2014 |