Healthcare Provider Details

I. General information

NPI: 1225294531
Provider Name (Legal Business Name): JENNIFER ANNE TEDCASTLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 NEW DURHAM RD
ALTON NH
03809-4917
US

IV. Provider business mailing address

27 NEW DURHAM RD
ALTON NH
03809-4917
US

V. Phone/Fax

Practice location:
  • Phone: 603-875-6151
  • Fax: 603-875-6152
Mailing address:
  • Phone: 603-875-6151
  • Fax: 603-875-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0527
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: