Healthcare Provider Details

I. General information

NPI: 1982542494
Provider Name (Legal Business Name): JESSIE LIND RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 NW 3RD ST
GRAND RAPIDS MN
55744-2135
US

IV. Provider business mailing address

2310 NW 3RD ST
GRAND RAPIDS MN
55744-2135
US

V. Phone/Fax

Practice location:
  • Phone: 218-410-9739
  • Fax:
Mailing address:
  • Phone: 218-410-9739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13926
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: