Basic Information
| Provider Information | |||||||||
| NPI: | 1184827560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRESS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 S CLIFF AVE | ||||||||
| Address2: | PO BOX 5045 PT FINANCIAL SERVICES | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053228000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1325 S CLIFF AVE | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053228000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 04/17/2013 | ||||||||
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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 | 207P00000X | 4301085735 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | 4301085735 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 7270 | SD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7270 | 01 | DAKOTACARE | OTHER | 6632110 | 05 | SD | MEDICAID | P00648293 | 01 | SD | RAILROAD MEDICARE | OTHER | 1184827560 | 01 | BCBS MN | OTHER | 1184827560 | 05 | MN | MEDICAID | 46022474331 | 05 | NE | MEDICAID | 1184827560 | 01 | WELLMARK BCBS SD | OTHER | 1184827560 | 05 | IA | MEDICAID |