Jacquelyn Ann Hedstrom, DNP APRN PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R20596 Issued in ND

Practice address

1000 Highway 12
Hettinger, ND 58639-7530

Phone

(701) 567-4561

NPI assigned

Oct 12, 2017

Last updated

Oct 12, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ND, SD2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Three Rivers Mental Health and Chemical Dependency CenterGroup PAC ID 7315380185, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Three Rivers Mental Health and Chemical Dependency Center

  dba Three Rivers Counseling

  • Mental Health Counselor
  • Lemmon, SD
  • NPI 1811001985

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• West River Health Services

  dba Hettinger Clinic

  • Critical Access Hospital Clinic/Center
  • Hettinger, ND
  • NPI 1174606271
  Medicare reassignment NPD
• West River Health Services

  dba West River Regional Medical Center

  • Critical Access Hospital
  • Hettinger, ND
  • NPI 1588763247
  Medicare reassignment NPD
• West River Health Services

  dba West River Foot and Ankle Center

  • Clinic/Center
  • Dickinson, ND
  • NPI 1629169008
  NPD
• West River Health Services

  dba West River Regional Medical Center

  • Physical Therapy Clinic/Center
  • Mott, ND
  • NPI 1902526411
  NPD

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

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507766400000",
    "number": "1891206215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11506 FREDLUND RD",
            "city": "HETTINGER",
            "state": "ND",
            "postal_code": "586399271",
            "telephone_number": "701-928-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HIGHWAY 12",
            "city": "HETTINGER",
            "state": "ND",
            "postal_code": "586397530",
            "telephone_number": "701-567-4561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEDSTROM",
        "first_name": "JACQUELYN",
        "middle_name": "ANN",
        "credential": "DNP APRN PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-12",
        "last_updated": "2017-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ND",
            "license": "R20596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert E Grossman, MD
• Robert J Gustafson, MD
• Susan K Hallen
• Suzan Jean Hanson, DC
• Lynly J Hebert, MS OTR L
• Helen Andrea Henley
• Hettinger Family Dental, P.C.
• Kent R Hoerauf, MD
• Rebecca Howe, APRN, FNP-C
• Courtney Hulm

• Psychiatric/Mental Health Nurse Practitioner in Hettinger, ND
• Providers in Hettinger, ND by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.