Provider Demographics
NPI:1245058791
Name:WINKLER, JESSIE RAE
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:RAE
Last Name:WINKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:RAE
Other - Last Name:WINKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 HAWK DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6426
Mailing Address - Country:US
Mailing Address - Phone:406-868-8344
Mailing Address - Fax:
Practice Address - Street 1:2012 14TH ST SW STE 2
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-3412
Practice Address - Country:US
Practice Address - Phone:406-758-7490
Practice Address - Fax:406-758-7080
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT241782363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics