Healthcare Provider Details

I. General information

NPI: 1861702243
Provider Name (Legal Business Name): JESSI LYNN OSBORNE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT STREET MEMORIAL BUILDING, WEST, FLOOR 1
CONCORD NH
03301-5046
US

IV. Provider business mailing address

246 PLEASANT STREET MEMORIAL BUILDING, WEST, FLOOR 1
CONCORD NH
03301-5046
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-1111
  • Fax: 603-226-4314
Mailing address:
  • Phone: 603-228-1111
  • Fax: 603-226-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0797
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4104
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: