Healthcare Provider Details

I. General information

NPI: 1497630446
Provider Name (Legal Business Name): GRANITE PRIDE NEW HAMPSHIRE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WARREN ST STE 3
CONCORD NH
03301-4030
US

IV. Provider business mailing address

5 WARREN ST STE 3
CONCORD NH
03301-4030
US

V. Phone/Fax

Practice location:
  • Phone: 603-227-6047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SMITH
Title or Position: APRN, FNP-C/ OWNER
Credential: APRN
Phone: 603-227-6047