Provider Demographics
NPI:1760615785
Name:MCPHATE, JESSA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSA
Middle Name:
Last Name:MCPHATE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JESSA
Other - Middle Name:
Other - Last Name:SHAW-BATTISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 W 29TH ST FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5105
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:30 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2304
Practice Address - Country:US
Practice Address - Phone:212-530-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33 335888363LF0000X
NY22 588862163W00000X
DCRN1014555163W00000X, 363LF0000X
MARN2299304363LF0000X
NH084285-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse