Provider Demographics
NPI:1942307673
Name:JESSEN-MATHER, KRISTINE L (NP #NPF4647)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:L
Last Name:JESSEN-MATHER
Suffix:
Gender:F
Credentials:NP #NPF4647
Other - Prefix:MS
Other - First Name:KRIS
Other - Middle Name:L
Other - Last Name:JESSEN-MATHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP #NPF4647
Mailing Address - Street 1:140 LITTON DR. #100
Mailing Address - Street 2:PO BOX 459001
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-477-4016
Mailing Address - Fax:530-477-4018
Practice Address - Street 1:140 LITTON DR. #100
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-477-4016
Practice Address - Fax:530-477-4018
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 4647363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 4647OtherNURSE PRACT. CERTIFICATIO