Provider Demographics
NPI:1861702243
Name:OSBORNE, JESSI LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:LYNN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 PLEASANT STREET MEMORIAL BUILDING, WEST, FLOOR 1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5046
Mailing Address - Country:US
Mailing Address - Phone:603-228-1111
Mailing Address - Fax:603-226-4314
Practice Address - Street 1:246 PLEASANT STREET MEMORIAL BUILDING, WEST, FLOOR 1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5046
Practice Address - Country:US
Practice Address - Phone:603-228-1111
Practice Address - Fax:603-226-4314
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0797363A00000X
MAPA4104363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30338487Medicaid
NH30338487Medicaid