Provider Demographics
NPI:1215346937
Name:BAIROS, JESSICA L (CPNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:BAIROS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:874 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6232
Mailing Address - Country:US
Mailing Address - Phone:508-992-6553
Mailing Address - Fax:
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-992-6553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2280032363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics