Healthcare Provider Details

I. General information

NPI: 1275174641
Provider Name (Legal Business Name): JESSICA LYNN SPAULDING MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 S MINNESOTA AVE
SIOUX FALLS SD
57108-2549
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-5800
  • Fax: 605-312-9031
Mailing address:
  • Phone: 605-328-9419
  • Fax: 605-312-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7103
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200514
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: