Provider Demographics
NPI:1255763900
Name:TEWES, JACKIE KAY (RN, CNP)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:KAY
Last Name:TEWES
Suffix:
Gender:
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7165 OAKRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-5514
Mailing Address - Country:US
Mailing Address - Phone:402-670-4054
Mailing Address - Fax:
Practice Address - Street 1:1601 SAINT FRANCIS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3383
Practice Address - Country:US
Practice Address - Phone:952-428-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR206715-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily