Prairie Phoenix PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

PRAIRIE PHOENIX PLLC

Practice address

120 N Wind St
Flandreau, SD 57028-1245

Phone

(605) 428-3040

NPI assigned

May 20, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abbey Kitto, DNP

Title

Authorized Official

Phone

(605) 428-3040

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1942875166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 W 10TH ST APT 6",
            "city": "DELL RAPIDS",
            "state": "SD",
            "postal_code": "570221524",
            "telephone_number": "605-428-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N WIND ST",
            "city": "FLANDREAU",
            "state": "SD",
            "postal_code": "570281245",
            "telephone_number": "605-428-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE PHOENIX PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A",
        "authorized_official_last_name": "KITTO",
        "authorized_official_first_name": "ABBEY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "605-428-3040",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "363LF0000X",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Petersen, ATC
• Jeffery Lee Peterson, M.D.
• Mariah Peterson, CNP
• Scott Peterson, MD
• James Edson Powell, M.D.
• Lacey M Richard I, LPC-MH, CAC QMHP
• Riverview Assisted Care L.L.P.
• Riverview Health Services, Inc
• Riverview SNF Operations, LLC
• Bailey Ross

• All providers in Flandreau, SD
• Family Nurse Practitioner in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.