Basic Information
| Provider Information | |||||||||
| NPI: | 1023423126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUGHLEY | ||||||||
| FirstName: | JACLYN | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 6TH ST SE | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587014028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788355696 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 BURDICK EXPY E | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587014768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018575000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2014 | ||||||||
| LastUpdateDate: | 06/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R40124 | ND | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN228489 | MA | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN615775 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | R40124 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.