Provider Demographics
NPI:1083373963
Name:MARTIN, JESSICA (CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S. SANSOME ST.
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:MT
Mailing Address - Zip Code:59858
Mailing Address - Country:US
Mailing Address - Phone:406-859-3271
Mailing Address - Fax:406-859-3011
Practice Address - Street 1:310 S SANSOME ST.
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:MT
Practice Address - Zip Code:59858
Practice Address - Country:US
Practice Address - Phone:406-859-3271
Practice Address - Fax:406-859-3011
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-185342207Q00000X
MT185342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine