Provider Demographics
NPI:1316342363
Name:STEVENS, JACLYN PALKERT (DO)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:PALKERT
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:PALKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:1601 SAINT FRANCIS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3384
Practice Address - Country:US
Practice Address - Phone:952-428-3535
Practice Address - Fax:952-428-3599
Is Sole Proprietor?:No
Enumeration Date:2014-11-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN67570207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program