Healthcare Provider Details

I. General information

NPI: 1760318810
Provider Name (Legal Business Name): JAKENDA MARIE SHORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 4TH ST N
CARRINGTON ND
58421-1217
US

IV. Provider business mailing address

800 4TH ST N
CARRINGTON ND
58421-1217
US

V. Phone/Fax

Practice location:
  • Phone: 701-797-7115
  • Fax:
Mailing address:
  • Phone: 701-797-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2879
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: