Provider Demographics
NPI:1144320300
Name:REIGHLEY, JESSIE M (NP)
Entity type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:M
Last Name:REIGHLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARINA RD
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6783
Mailing Address - Country:US
Mailing Address - Phone:207-846-6163
Mailing Address - Fax:207-846-6167
Practice Address - Street 1:3 MARINA RD
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6783
Practice Address - Country:US
Practice Address - Phone:207-846-6163
Practice Address - Fax:207-846-6167
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER026162363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES60980Medicare UPIN
MEUX2710Medicare PIN