Provider Demographics
NPI:1538807581
Name:FUKS, AUDREY JEAN (PMHNP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:JEAN
Last Name:FUKS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 W CITY LIMITS RD APT 116
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-1238
Mailing Address - Country:US
Mailing Address - Phone:605-660-4073
Mailing Address - Fax:
Practice Address - Street 1:100 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5915
Practice Address - Country:US
Practice Address - Phone:605-444-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002406363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health