Provider Demographics
NPI:1598169013
Name:PERRONE, JESSICA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:PERRONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:KONOPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:60 COMMERCIAL ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5071
Mailing Address - Country:US
Mailing Address - Phone:603-228-1763
Mailing Address - Fax:
Practice Address - Street 1:60 COMMERCIAL ST
Practice Address - Street 2:SUITE 404
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5071
Practice Address - Country:US
Practice Address - Phone:603-228-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1052363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3099429Medicaid