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AVERA MEDICAL GROUP FUNCTIONAL MEDICINE
NPI 1255307450
Nurse Practitioner - Women's Health in Sioux Falls, SD

Active since February 27, 2006
911 E 20TH ST, STE 200, SIOUX FALLS, SD 57105(605) 322-3455(605) 322-3456 Get Directions Write a Review

NPPES record last updated: February 16, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 16, 2021, Oct 24, 2018 (2 updates tracked since 2018).

About Avera Medical Group Functional Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AVERA MEDICAL GROUP FUNCTIONAL MEDICINE (NPI 1255307450) is a healthcare organization registered as a women's health in Sioux Falls, South Dakota and active in the NPI registry since February 2006. The organization lists David Flicek, Ceo/president, as its authorized official.

NPPES Registry Identity

NPI1255307450
Entity TypeOrganization
Primary Taxonomy363LW0102X
Legal Business NameAVERA MCKENNAN
Location Address911 E 20TH ST, STE 200Sioux Falls, SD 57105-1042
Mailing AddressPo Box 86370Sioux Falls, SD 57118-6370 · (605) 322-7510 · Fax (605) 322-6475
Phone(605) 322-3455
Fax(605) 322-3456
Organization SubpartNo
Authorized OfficialDavid FlicekCeo/president · (605) 322-8000
Enumeration DateFebruary 27, 2006
Last NPPES UpdateFebruary 16, 20212 updates tracked since enumeration
NPPES CertifiedFebruary 16, 2021
✔ NPI 1255307450 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Women's HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LW0102X
911 E 20TH ST, Sioux Falls, SD 57105
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Other Names 1

Doing Business AsAvera Medical Group Functional Medicine

Other Identifiers 9

Medicaid0748939IA
Other9177384SD · Dakotacare
Medicaid10025120100NE
Medicaid775790500MN
Other370624200SD · Dept Of Labor
Other67B25MIMN · Blue Plus
Other67B25MIMN · Bcbs
Other74474SD · Healthpartners
Other0007280SD · Bcbs

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRADLEY CLARK THAEMERT MD
Surgery
911 E 20TH ST, STE 700
SIOUX FALLS, SD 57105
Minnehaha County (605) 334-0393
EBRU SULANC M.D.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
911 E 20TH ST, STE 500
SIOUX FALLS, SD 57105
Minnehaha County (605) 322-7600
MICHAEL R. PUUMALA, M.D.,P.C.
Specialist
911 E 20TH ST, SUITE 400
SIOUX FALLS, SD 57105
Minnehaha County (605) 322-8860
MS. CHERI L. KOVALENKO CNP
Nurse Practitioner (Family)
911 E 20TH ST, SUITE 303
SIOUX FALLS, SD 57105
Minnehaha County (605) 322-3440
MARY E. KINNEY RN
Registered Nurse
911 E 20TH ST
SIOUX FALLS, SD 57105
Minnehaha County (605) 322-8000
JAMIE ELIZABETH VAN LENT
Nurse Practitioner (Acute Care)
911 E 20TH ST
SIOUX FALLS, SD 57105
Minnehaha County (605) 334-0393
HARI D KANNAN M.D.
Psychiatry & Neurology (Psychiatry)
911 E 20TH ST, STE. 403
SIOUX FALLS, SD 57105
Minnehaha County (605) 322-7516
DONALD T BISHOP MD
Internal Medicine (Cardiovascular Disease)
911 E 20TH ST, SUITE 405
SIOUX FALLS, SD 57105
Minnehaha County (605) 322-3050

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Avera Mckennan's NPI number?

The NPI number for Avera Mckennan is 1255307450. It was assigned to this organization in the NPPES registry on February 27, 2006. The provider is doing business as Avera Medical Group Functional Medicine.

Where is Avera Mckennan located?

Avera Mckennan is located at 911 E 20th St Ste 200, Sioux Falls, SD 57105. The listed phone number is (605) 322-3455.

What is Avera Mckennan's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Women's Health, with taxonomy code 363LW0102X.

When was this NPI record last updated?

The NPPES record for Avera Mckennan was last updated on February 16, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.