Individual
MS. JADE LYNN WHITESELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2251
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2251
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0423
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106964534
DUNS & BRADSTREET
SD
01
—
84179880
TPIN
SD
Enumeration date
08/18/2006
Last updated
03/07/2023
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