Provider Demographics
NPI:1558709477
Name:KRASS, JESSICA A (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:KRASS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LAHEY HOSPITAL AND MEDICAL CENTER
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-372-7100
Mailing Address - Fax:781-372-7111
Practice Address - Street 1:16 HAYDEN AVE
Practice Address - Street 2:LAHEY HEALTH PRIMARY, LEXINGTON
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7929
Practice Address - Country:US
Practice Address - Phone:781-372-7100
Practice Address - Fax:781-372-7111
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2306399363L00000X
NY588711163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY130904000113OtherFIDELIS CARE NY
NY03594429Medicaid
NYJ400100250Medicare PIN