Provider Demographics
NPI:1205436011
Name:HENNEN, JESSICA EMILY (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EMILY
Last Name:HENNEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 OLD SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04548-3915
Mailing Address - Country:US
Mailing Address - Phone:919-636-2524
Mailing Address - Fax:
Practice Address - Street 1:195 UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-6107
Practice Address - Country:US
Practice Address - Phone:207-706-5030
Practice Address - Fax:877-343-6641
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2112363A00000X
NHEL31989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant