Provider Demographics
NPI:1417454349
Name:KHALID, JESSICA JEAN (NP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:JEAN
Last Name:KHALID
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JEAN
Other - Last Name:LAMPHERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:357 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2658
Mailing Address - Country:US
Mailing Address - Phone:315-363-4651
Mailing Address - Fax:315-363-2821
Practice Address - Street 1:357 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2658
Practice Address - Country:US
Practice Address - Phone:315-361-4651
Practice Address - Fax:315-361-2821
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06646386Medicaid