Provider Demographics
NPI:1336302736
Name:FREE, JACQUELYN KAYE (FNP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:KAYE
Last Name:FREE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:KAYE
Other - Last Name:CAYKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:304 S ELLERY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:MT
Mailing Address - Zip Code:59221-7210
Mailing Address - Country:US
Mailing Address - Phone:406-742-5261
Mailing Address - Fax:
Practice Address - Street 1:304 S ELLERY AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:MT
Practice Address - Zip Code:59221-7210
Practice Address - Country:US
Practice Address - Phone:406-742-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29434363LF0000X
MT37798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily