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Contact Information

AVERA MCKENNAN
210 KASAN AVE
VOLGA, SD57071
 Phone: 605-627-5701
 Fax: 605-627-5990
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for AVERA MCKENNAN · (Female)

NPI # 1063432573
Status Active
Credentials
Entity Individual
Enumeration date 07/20/2006
Last updated 03/11/2011 - About 15 years ago
Sole proprietor 1 Not specified
Identifiers
  • SD License # 84
  • SD Medicaid 7300750
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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