Provider Demographics
NPI:1144845322
Name:COUPER, JESSICA L (CNM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:COUPER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 THORN TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3522
Mailing Address - Country:US
Mailing Address - Phone:203-449-7293
Mailing Address - Fax:
Practice Address - Street 1:1382 LANES MILL RD STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3894
Practice Address - Country:US
Practice Address - Phone:732-994-4242
Practice Address - Fax:732-363-5164
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00071100367A00000X
NJ25ME00071101367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife