Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | CP000942 | SD |
NPI | 1003203456 |
---|---|
Provider Name | Mrs. Jacklyn Ann Karli |
First Address | Watertown, SD 57201-1548 |
Second Address | Watertown, SD 57201-1548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 23/04/2015 |