Individual
JACK GAVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
314 S MAIN ST, CONCORD, NH 03301-3468
(603) 568-7867
(603) 410-6682
Mailing address
26 NORWICH ST, CONCORD, NH 03301-2216
(603) 568-7867
(603) 410-6682
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
047435-23-03
NH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
047435-23-08
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30342516
—
NH
Enumeration date
12/08/2006
Last updated
09/11/2025
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