Healthcare Provider Details

I. General information

NPI: 1902721483
Provider Name (Legal Business Name): JACLYNN SMALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 22ND ST
SIOUX FALLS SD
57105-1305
US

IV. Provider business mailing address

710 E HERMOSA DR
SIOUX FALLS SD
57104-0756
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-3230
  • Fax:
Mailing address:
  • Phone: 605-336-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR037275
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: