Provider Demographics
NPI:1518521442
Name:PORTER, JACQUELINE ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:PORTER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANN
Other - Last Name:MCCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2937
Mailing Address - Country:US
Mailing Address - Phone:603-642-3910
Mailing Address - Fax:603-642-3940
Practice Address - Street 1:53 CHURCH ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-9997
Practice Address - Country:US
Practice Address - Phone:603-642-3910
Practice Address - Fax:603-642-3940
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH063965-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily