Basic Information
| Provider Information | |||||||||
| NPI: | 1841239290 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUHNERKOCH | ||||||||
| FirstName: | KAY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3450 | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577093450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057226101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61 CHARLES ST | ||||||||
| Address2: | |||||||||
| City: | DEADWOOD | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577321303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057226101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 02/23/2008 | ||||||||
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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 | R94180 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2775 | 01 | SD | DAKOTACARE | OTHER | 5752175 | 05 | SD | MEDICAID | 0008584 | 01 | SD | WELLMARK | OTHER | 6821457 | 05 | SD | MEDICAID |