Healthcare Provider Details

I. General information

NPI: 1245058791
Provider Name (Legal Business Name): JESSIE RAE WINKLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE RAE WINKLER

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 14TH ST SW STE 2
GREAT FALLS MT
59404-3412
US

IV. Provider business mailing address

37 HAWK DR
GREAT FALLS MT
59404-6426
US

V. Phone/Fax

Practice location:
  • Phone: 406-758-7490
  • Fax: 406-758-7080
Mailing address:
  • Phone: 406-868-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number241782
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: