Basic Information
| Provider Information | |||||||||
| NPI: | 1518684265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERTRAND | ||||||||
| FirstName: | KAYLEE | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6508 W 56TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571061959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123014727 | ||||||||
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| Practice Location | |||||||||
| Address1: | 345 W STEAMBOAT DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052172175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2022 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | R056747 | SD | Y | Nursing Service Providers | Registered Nurse | Medical-Surgical |
No ID Information.