Individual
TIA KAY HETLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
601 E 7TH ST, SUITE 3, PLATTE, SD 57369-2123
(605) 337-3364
(605) 337-3360
Mailing address
PO BOX 818, PLATTE, SD 57369-0818
(605) 337-3364
(605) 337-3360
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0862
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S107304
MEDICARE PTAN
SD
Enumeration date
04/16/2013
Last updated
05/03/2023
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