Active NPI
Jenna Rae Young, PHARMD
- Ambulatory Care Pharmacist
- Fargo, ND
National Provider Identifier
1912483363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Care Pharmacist
- License
- 123786
- Practice address
- 2101 Elm St N
Fargo, ND 58102-2417 - Phone
- (701) 232-3241
- NPI assigned
- Jul 18, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Care Pharmacist | 1835P2201X | 123786 | MN | Primary |
Addresses
Primary practice location
2101 Elm St N
Fargo, ND 58102-2417
Mailing address
PO Box 5010
Minot, ND 58702-5010
Phone (701) 418-8000
Other practice location 1
400 Burdick Expy E
Minot, ND 58701-4768
Phone (701) 418-8000
Other practice location 2
2305 37th Ave SW
Minot, ND 58701-7669
Phone (701) 418-8000
Other practice location 3
1200 6th Ave N
Saint Cloud, MN 56303-2735
Phone (320) 252-5131 ext. 52060
Other names 1
- Dr. Jenna Rae Gullickson
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 123786 | MN | MD | Ambulatory Care Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773705600000",
"number": "1912483363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5010",
"city": "MINOT",
"state": "ND",
"postal_code": "587025010",
"telephone_number": "701-418-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 ELM ST N",
"city": "FARGO",
"state": "ND",
"postal_code": "581022417",
"telephone_number": "701-232-3241"
}
],
"practiceLocations": [
{
"address_1": "400 Burdick Expy E",
"address_purpose": "LOCATION",
"city": "Minot",
"state": "ND",
"postal_code": "587014768",
"country_code": "US",
"telephone_number": "701-418-8000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2305 37th Ave SW",
"address_purpose": "LOCATION",
"city": "Minot",
"state": "ND",
"postal_code": "587017669",
"country_code": "US",
"telephone_number": "701-418-8000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1200 6th Ave N",
"address_purpose": "LOCATION",
"city": "Saint Cloud",
"state": "MN",
"postal_code": "563032735",
"country_code": "US",
"telephone_number": "320-252-5131 x52060",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "YOUNG",
"first_name": "JENNA",
"middle_name": "RAE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-18",
"last_updated": "2026-03-17",
"certification_date": "2026-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "MN",
"license": "123786",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.1068.1",
"affiliationName": "Cobius Healthcare Solutions",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "2720 Dundee Rd # 302",
"city": "Northbrook",
"state": "IL",
"country_code": "US",
"postal_code": "600622609",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "JENNA",
"last_name": "GULLICKSON",
"middle_name": "RAE",
"prefix": "DR.",
"credential": "PHARMD",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.