Provider Demographics
NPI:1518731991
Name:PRATT, JESSICA NICOLE (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NICOLE
Last Name:PRATT
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1171
Mailing Address - Country:US
Mailing Address - Phone:248-505-5405
Mailing Address - Fax:
Practice Address - Street 1:159 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1171
Practice Address - Country:US
Practice Address - Phone:248-505-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704327430363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner