Provider Demographics
NPI:1487801445
Name:CORKLE, KRISTEN M (CNP, FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:CORKLE
Suffix:
Gender:F
Credentials:CNP, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 KANSAS CITY ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3673
Mailing Address - Country:US
Mailing Address - Phone:605-791-2500
Mailing Address - Fax:605-791-2502
Practice Address - Street 1:521 KANSAS CITY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3673
Practice Address - Country:US
Practice Address - Phone:605-791-2500
Practice Address - Fax:605-791-2502
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000538363L00000X, 363LF0000X, 363LP0808X
SDR028596163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200686140AMedicaid
SD1487801445Medicaid
SDP00637343Medicare PIN
SD1487801445Medicaid