Provider Demographics
NPI:1497531792
Name:PARENT, JESSICA LORRAINE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LORRAINE
Last Name:PARENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 STACY RD
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03884-6391
Mailing Address - Country:US
Mailing Address - Phone:603-833-8288
Mailing Address - Fax:
Practice Address - Street 1:311 ROUTE 108
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1522
Practice Address - Country:US
Practice Address - Phone:917-664-3892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH074359-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner