Healthcare Provider Details

I. General information

NPI: 1356258511
Provider Name (Legal Business Name): JILLIAN LEIGH AUGUSTAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILLIAN LEIGH SHAY

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 S LYNCREST PL
SIOUX FALLS SD
57108-2756
US

IV. Provider business mailing address

7309 W 12TH ST
SIOUX FALLS SD
57106-5801
US

V. Phone/Fax

Practice location:
  • Phone: 605-553-1721
  • Fax:
Mailing address:
  • Phone: 605-553-1721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR040359
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: