Provider Demographics
NPI:1275174641
Name:SPAULDING, JESSICA LYNN (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 2ND AVE NE STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1226
Mailing Address - Country:US
Mailing Address - Phone:320-428-0744
Mailing Address - Fax:320-438-2829
Practice Address - Street 1:105 2ND AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1226
Practice Address - Country:US
Practice Address - Phone:320-428-0744
Practice Address - Fax:320-438-2829
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7103363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health