Healthcare Provider Details

I. General information

NPI: 1326230210
Provider Name (Legal Business Name): JESSICA ANN HINKLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANN HINKLEY RN

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 S 6TH ST
BRAINERD MN
56401-4529
US

IV. Provider business mailing address

1702 UNIVERSITY DR S
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-7101
  • Fax: 218-828-2892
Mailing address:
  • Phone: 701-364-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP0586
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: