Healthcare Provider Details

I. General information

NPI: 1376939512
Provider Name (Legal Business Name): JESSICA STARR MS, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WEST ST
KEENE NH
03431-3355
US

IV. Provider business mailing address

19 WEST ST
KEENE NH
03431-3355
US

V. Phone/Fax

Practice location:
  • Phone: 603-338-6065
  • Fax:
Mailing address:
  • Phone: 312-622-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number084300-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.366645
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: