Provider Demographics
NPI:1699731158
Name:NEHLICH, KAREN S (PA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:NEHLICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:S
Other - Last Name:JUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3015 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1846
Practice Address - Country:US
Practice Address - Phone:605-725-1700
Practice Address - Fax:605-725-1761
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0562363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6825542Medicaid
SD6825542Medicaid
SDS100374Medicare PIN
SDP00730152Medicare PIN