Basic Information
| Provider Information | |||||||||
| NPI: | 1700465192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | RAELIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2612 MEADOWS DR | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577851702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074210186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1420 N 10TH ST | ||||||||
| Address2: | |||||||||
| City: | SPEARFISH | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577831532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057178595 | ||||||||
| FaxNumber: | 6057178618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2021 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CP002026 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.