Active NPI
Patricia Lynn Annetts, FNP
- Nurse Practitioner
- Custer, SD
National Provider Identifier
1700448206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- CP001590
- Practice address
- 1065 Montgomery St
Custer, SD 57730-1304 - Phone
- (605) 673-2237
- Fax
- (605) 673-3593
- NPI assigned
- Jul 3, 2019
- Last updated
- May 20, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | CP001590 | SD | Primary |
Addresses
Primary practice location
1065 Montgomery St
Custer, SD 57730-1304
Mailing address
1065 Montgomery St
Custer, SD 57730-1304
Phone (605) 673-2237
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP001590 | SD | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589932800000",
"number": "1700448206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1065 MONTGOMERY ST",
"city": "CUSTER",
"state": "SD",
"postal_code": "577301304",
"telephone_number": "605-673-2237",
"fax_number": "605-673-3593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1065 MONTGOMERY ST",
"city": "CUSTER",
"state": "SD",
"postal_code": "577301304",
"telephone_number": "605-673-2237",
"fax_number": "605-673-3593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANNETTS",
"first_name": "PATRICIA",
"middle_name": "LYNN",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-03",
"last_updated": "2020-05-20",
"certification_date": "2020-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "SD",
"license": "CP001590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Custer, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.