Provider Demographics
NPI:1023466562
Name:CLOUTIER, JESSE R (PA)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:R
Last Name:CLOUTIER
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Gender:M
Credentials:PA
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Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-5770
Mailing Address - Fax:207-664-5777
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-664-5770
Practice Address - Fax:207-664-5777
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2023-11-20
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Provider Licenses
StateLicense IDTaxonomies
MEPA1602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant