Basic Information
| Provider Information | |||||||||
| NPI: | 1174711840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUIPER | ||||||||
| FirstName: | GARNETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALTENA | ||||||||
| OtherFirstName: | GARNETH | ||||||||
| OtherMiddleName: | E. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 W 69TH ST | ||||||||
| Address2: | STE. 1500 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053225700 | ||||||||
| FaxNumber: | 6053225704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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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 | 363LP0808X | TEMPORARY - CNP APP | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 254873 | 01 | SD | MIDLANDS CHOICE | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 57108C038 | 01 | SD | WPS TRICARE | OTHER | 37L31KU | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 412991053244 | 01 | SD | PREFERRED ONE | OTHER | 9253810 | 01 | SD | DAKOTACARE | OTHER | 106687000 | 05 | MN | MEDICAID | 1174711840 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 4992660 | 01 | SD | BLUE CROSS | OTHER | 040121002 | 01 | MN | PRIMEWEST | OTHER | 12200 | 05 | ND | MEDICAID | 46022474352 | 05 | NE | MEDICAID | 3148379 | 05 | IA | MEDICAID | HP85930 | 01 | SD | HEALTHPARTNERS | OTHER |