Provider Demographics
NPI:1255573408
Name:KAPPENMAN, ANDREW THOMAS
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:KAPPENMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SETH ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-2530
Mailing Address - Country:US
Mailing Address - Phone:605-929-0764
Mailing Address - Fax:
Practice Address - Street 1:520 S SANTA FE AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-827-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR031721367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered