Healthcare Provider Details

I. General information

NPI: 1700719424
Provider Name (Legal Business Name): JACKLYN KNUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28322 330TH WAY
ADEL IA
50003-8666
US

IV. Provider business mailing address

28322 330TH WAY
ADEL IA
50003-8666
US

V. Phone/Fax

Practice location:
  • Phone: 515-229-1312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number131986
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: