Provider Demographics
NPI:1831825025
Name:SMITH, JESSICA KATHRYN (DNP, CRNP)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:KATHRYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, CRNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KATHRYN
Other - Last Name:EGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-775-0000
Mailing Address - Fax:603-775-0247
Practice Address - Street 1:21 HAMPTON RD BLDG 3
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4831
Practice Address - Country:US
Practice Address - Phone:603-775-0000
Practice Address - Fax:603-775-0247
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH089082363LP2300X
NH089082-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care