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Organization
JACKIE D. STEVENS
Active
Organization
JACKIE D. STEVENS
Active
Other names
Psychiatric Med Management
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE DEE STEVENS (AUTHORIZED OFFICIAL)
(507) 288-6978
Entity
Organization
Contact information
Practice address
59516 390TH AVE, ZUMBRO FALLS, MN 55991-5161
(507) 398-9086
Mailing address
59516 390TH AVE, ZUMBRO FALLS, MN 55991-5161
(507) 398-9086
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/06/2023
Last updated
07/18/2023
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