Organization
TRI STATE MEDICAL CENTER PLLC
Active
Other names
Tri State Medical Center PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA KUDLOCK CNP (OWNER)
(605) 568-0191
Entity
Organization
Contact information
Practice address
2398 5TH AVE STE 101, BELLE FOURCHE, SD 57717-2340
(605) 645-2064
Mailing address
2398 5TH AVE STE 101, BELLE FOURCHE, SD 57717-2340
(605) 645-2064
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/13/2023
Last updated
01/11/2024
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