Provider Demographics
NPI:1922986447
Name:JESSEN, KAYLA MARIE (OWNER)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:JESSEN
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:SD
Mailing Address - Zip Code:57469-2026
Mailing Address - Country:US
Mailing Address - Phone:605-472-2191
Mailing Address - Fax:
Practice Address - Street 1:1010 W 5TH ST
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:SD
Practice Address - Zip Code:57469-2026
Practice Address - Country:US
Practice Address - Phone:605-472-2191
Practice Address - Fax:605-472-2194
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD40127310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility