Provider Demographics
NPI:1831984483
Name:SCOTTING, JACKIE MARIE (RN)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:MARIE
Last Name:SCOTTING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26506 456TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:SD
Mailing Address - Zip Code:57035-6801
Mailing Address - Country:US
Mailing Address - Phone:605-261-7167
Mailing Address - Fax:
Practice Address - Street 1:26506 456TH AVE
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:SD
Practice Address - Zip Code:57035-6801
Practice Address - Country:US
Practice Address - Phone:605-261-7167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR042036163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse