Healthcare Provider Details

I. General information

NPI: 1962335844
Provider Name (Legal Business Name): JESSICA LYNN VELZKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STATE AVE
FARIBAULT MN
55021-6337
US

IV. Provider business mailing address

100 STATE AVE
FARIBAULT MN
55021-6337
US

V. Phone/Fax

Practice location:
  • Phone: 507-334-6451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14293
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: