Healthcare Provider Details

I. General information

NPI: 1669376042
Provider Name (Legal Business Name): JACQUELINE STEAN NP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 W 1170 N
DRIGGS ID
83422
US

IV. Provider business mailing address

PO BOX 1155
DRIGGS ID
83422-1155
US

V. Phone/Fax

Practice location:
  • Phone: 307-284-5401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACQUELINE STEAN
Title or Position: OWNER, NURSE PRACTITIONER
Credential: NP
Phone: 307-284-5401