Provider Demographics
NPI:1053419903
Name:KAFFAR, PAUL R (CNP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:KAFFAR
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:6100 S LOUISE AVE STE 1120
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6021
Practice Address - Country:US
Practice Address - Phone:605-504-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE46022474335Medicaid
SD769201048412OtherPREFERRED ONE
SDHP71462OtherHEALTHPARTNERS
MN070107000Medicaid
SD2444134OtherARAZ/ AMERICA'S PPO
IA0545186Medicaid
SDCP000478OtherCNP LICENSE
SD0125073OtherMEDICA
SD4993678OtherBLUE CROSS
MN500L7KAOtherCC SYSTEMS/ BLUE PLUS
SD57105F018OtherWPS TRICARE
MN92411422901OtherPRIMEWEST
SDP00446747OtherRR MEDICARE
SD370624200OtherDEPT OF LABOR
SD251572OtherMIDLANDS CHOICE
SD9240659OtherDAKOTACARE
SDR027066OtherRN LICENSE
MN92411422901OtherPRIMEWEST