Provider Demographics
NPI:1417316241
Name:POWERS, JESSICA (APN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MELCHIOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:27 PINCKNEY RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2179
Mailing Address - Country:US
Mailing Address - Phone:732-747-4600
Mailing Address - Fax:
Practice Address - Street 1:27 PINCKNEY RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2179
Practice Address - Country:US
Practice Address - Phone:732-747-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00622400363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology