Provider Demographics
NPI:1982209169
Name:HEPPER, JAYDIN A
Entity Type:Individual
Prefix:
First Name:JAYDIN
Middle Name:A
Last Name:HEPPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2608
Mailing Address - Country:US
Mailing Address - Phone:701-509-1690
Mailing Address - Fax:
Practice Address - Street 1:624 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2608
Practice Address - Country:US
Practice Address - Phone:701-509-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1286899240010OtherBLUE CROSS BLUE SHEILD