Provider Demographics
NPI:1609022474
Name:REED, JESSICA R (MSN, GNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:REED
Suffix:
Gender:F
Credentials:MSN, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 KENNEDY MEMORIAL DR
Mailing Address - Street 2:STE 202 EVERGEREEN FAMILY PRACTICE
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4556
Mailing Address - Country:US
Mailing Address - Phone:207-873-6655
Mailing Address - Fax:207-877-9826
Practice Address - Street 1:246 KENNEDY MEMORIAL DR
Practice Address - Street 2:STE 202 EVERGEREEN FAMILY PRACTICE
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4556
Practice Address - Country:US
Practice Address - Phone:207-873-6655
Practice Address - Fax:207-877-9826
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER054879363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433129799Medicaid
ME433129799Medicaid