Provider Demographics
NPI:1861569659
Name:KLINKHAMMER, JOSHUA JAMES (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:JAMES
Last Name:KLINKHAMMER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2480
Mailing Address - Country:US
Mailing Address - Phone:605-696-9000
Mailing Address - Fax:605-696-7758
Practice Address - Street 1:300 22ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2480
Practice Address - Country:US
Practice Address - Phone:605-696-9000
Practice Address - Fax:605-696-7758
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCR000544163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD100884Medicare ID - Type UnspecifiedCRNA