Provider Demographics
NPI:1154916120
Name:MCNALLY, JESSICA M (FNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-1910
Mailing Address - Country:US
Mailing Address - Phone:215-630-5944
Mailing Address - Fax:
Practice Address - Street 1:25 MARSTON ST APT 202
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2357
Practice Address - Country:US
Practice Address - Phone:978-946-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner