Healthcare Provider Details

I. General information

NPI: 1023423126
Provider Name (Legal Business Name): JACLYN HUGHLEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BURDICK EXPY E
MINOT ND
58701-4768
US

IV. Provider business mailing address

104 6TH ST SE
MINOT ND
58701-4028
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-5000
  • Fax:
Mailing address:
  • Phone: 978-835-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR40124
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN228489
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN615775
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR40124
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: