Organization
PRAIRIE PHOENIX PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABBEY KITTO DNP (AUTHORIZED OFFICIAL)
(605) 428-3040
Entity
Organization
Contact information
Practice address
120 N WIND ST, FLANDREAU, SD 57028-1245
(605) 428-3040
Mailing address
330 W 10TH ST APT 6, DELL RAPIDS, SD 57022-1524
(605) 428-3040
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363LF0000X
LICENSE
SD
Enumeration date
05/20/2021
Last updated
05/28/2021
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