Basic Information
| Provider Information | |||||||||
| NPI: | 1144638453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HELDER | ||||||||
| FirstName: | KAITLIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4405 E 26TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571034187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053322883 | ||||||||
| FaxNumber: | 6053289001 | ||||||||
| Practice Location | |||||||||
| Address1: | 4405 E 26TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571034187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053322883 | ||||||||
| FaxNumber: | 6053289001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA60485695 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2038486 | 05 | WA | MEDICAID |