Provider Demographics
NPI:1588116073
Name:MERGENS, KIERSTIN REBECCA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KIERSTIN
Middle Name:REBECCA
Last Name:MERGENS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:KIERSTIN
Other - Middle Name:REBECCA
Other - Last Name:STREFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:411 STANFORD ST LOT 19
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-1716
Mailing Address - Country:US
Mailing Address - Phone:817-637-8787
Mailing Address - Fax:
Practice Address - Street 1:1101 NORTH DAKOTA STREET
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069
Practice Address - Country:US
Practice Address - Phone:605-658-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0488174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator