Healthcare Provider Details

I. General information

NPI: 1811847593
Provider Name (Legal Business Name): JODEE ECKART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 28TH AVE S STE 102
MOORHEAD MN
56560-4420
US

IV. Provider business mailing address

1132 28TH AVE S STE 102
MOORHEAD MN
56560-4420
US

V. Phone/Fax

Practice location:
  • Phone: 218-512-0630
  • Fax:
Mailing address:
  • Phone: 218-512-0630
  • Fax: 218-512-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number204287
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: