Healthcare Provider Details

I. General information

NPI: 1487501839
Provider Name (Legal Business Name): JADE PEARL MCGRANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19022 GOSPEL LN
BELLE FOURCHE SD
57717-7236
US

IV. Provider business mailing address

19022 GOSPEL LN
BELLE FOURCHE SD
57717-7236
US

V. Phone/Fax

Practice location:
  • Phone: 605-517-2221
  • Fax:
Mailing address:
  • Phone: 605-517-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number1043-3537-UT
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: