Provider Demographics
NPI:1518216928
Name:TERRIEN, JESSICA M (NPP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:TERRIEN
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0749
Mailing Address - Country:US
Mailing Address - Phone:802-888-8320
Mailing Address - Fax:802-888-8136
Practice Address - Street 1:65 NORTHGATE PLZ
Practice Address - Street 2:STE 11
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-888-8320
Practice Address - Fax:802-888-8136
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0107522363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8912655OtherMEDICARE
VT1024242Medicaid
NY401673OtherLICENSE
G8912655OtherMEDICARE