Healthcare Provider Details

I. General information

NPI: 1336903376
Provider Name (Legal Business Name): JACLYN ANN HUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 1ST AVE
FORT TOTTEN ND
58335-3519
US

IV. Provider business mailing address

PO BOX 359
FORT TOTTEN ND
58335-0359
US

V. Phone/Fax

Practice location:
  • Phone: 701-230-7115
  • Fax:
Mailing address:
  • Phone: 701-766-1296
  • Fax: 701-766-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: