Provider Demographics
NPI:1003162132
Name:RICHARDSON, JESSICA ADELAIDE (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ADELAIDE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:234 HARLOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:ME
Mailing Address - Zip Code:04282-3528
Mailing Address - Country:US
Mailing Address - Phone:207-212-5828
Mailing Address - Fax:
Practice Address - Street 1:92 CAMPUS DR STE D
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7229
Practice Address - Country:US
Practice Address - Phone:207-662-8900
Practice Address - Fax:207-774-9388
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP121059363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner