Active NPI
Jessica Nicole Souther
- Physician Assistant
- Revere, MA
National Provider Identifier
1669306791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 21 Revere Beach Blvd Apt 505
Revere, MA 02151-3771 - Phone
- (484) 798-8841
- NPI assigned
- Jun 12, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA | Primary |
Addresses
Primary practice location
21 Revere Beach Blvd Apt 505
Revere, MA 02151-3771
Mailing address
21 Revere Beach Blvd Apt 505
Revere, MA 02151-3771
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1781222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781222400000",
"number": "1669306791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 REVERE BEACH BLVD APT 505",
"city": "REVERE",
"state": "MA",
"postal_code": "021513771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 REVERE BEACH BLVD APT 505",
"city": "REVERE",
"state": "MA",
"postal_code": "021513771",
"telephone_number": "484-798-8841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHER",
"first_name": "JESSICA",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-06-12",
"last_updated": "2026-06-12",
"certification_date": "2026-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Revere, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.