NPIMap

Individual provider Active NPI

Jacqueline Rae Friede, APRN, FNP-C

  • Family Nurse Practitioner
  • Great Falls, MT
National Provider Identifier
1336858836
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
203969 Issued in MT
Practice address
2300 12TH Ave S Ste 101
Great Falls, MT 59405-5017
Phone
(406) 761-5252
NPI assigned
Nov 23, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 203969 MT Primary

Addresses

Primary practice location

2300 12TH Ave S Ste 101
Great Falls, MT 59405-5017

Mailing address

2300 12TH Ave S Ste 101
Great Falls, MT 59405-5017
Phone (406) 761-5252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230127001033 MT Practitioner - Nurse Practitioner 3476924531 Practice locations: Great Falls, MT

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2300 12TH Ave S
Suite 101
Great Falls, MT 59405-5017
Phone (406) 761-5252

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
203969MTMDFamily Nurse Practitioner

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1336858836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 12TH AVE S STE 101",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594055017",
            "telephone_number": "406-761-5252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 12TH AVE S STE 101",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594055017",
            "telephone_number": "406-761-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIEDE",
        "first_name": "JACQUELINE",
        "middle_name": "RAE",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-23",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MT",
            "license": "203969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Falls, MT

Sources for this page

Verify at the official NPI Registry.