AVERA MCKENNAN NPI 1255307450

NPI Information

NPI: 1255307450
Provider Name: AVERA MCKENNAN

Doing Business As: AVERA MEDICAL GROUP FUNCTIONAL MEDICINE

Classification: Nurse Practitioner - 363LW0102X
Entity Type: Organization

Specialization: Women's Health

Address:
911 E 20TH ST
STE 200
SIOUX FALLS, SD
ZIP 57105
Phone: (605) 322-3455
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AVERA MCKENNAN is a women's health nurse practitioner in Sioux Falls, SD. AVERA MCKENNAN NPI is 1255307450. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Avera Medical Group Functional Medicine.

The provider's business location address is:

911 E 20TH ST
STE 200
SIOUX FALLS, SD
ZIP 57105-042
Phone: (605) 322-3455
Fax: (605) 322-3456

The provider's authorized official is David Flicek .
The authorized official title is Ceo/president and has the following contact phone number (605) 322-8000.

The enumeration date for this NPI number is 2/27/2006 and was last updated on 2/16/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LW0102X	Nurse Practitioner	Women's Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0748939	MEDICAID	IOWA
2	9177384	OTHER	SOUTH DAKOTA	DAKOTACARE
3	10025120100	MEDICAID	NEBRASKA
4	775790500	MEDICAID	MINNESOTA
5	370624200	OTHER	SOUTH DAKOTA	DEPT OF LABOR
6	67B25MI	OTHER	MINNESOTA	BLUE PLUS
7	67B25MI	OTHER	MINNESOTA	BCBS
8	74474	OTHER	SOUTH DAKOTA	HEALTHPARTNERS
9	0007280	OTHER	SOUTH DAKOTA	BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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