JORDAN LYNNE SIDEBOTTOM PMHNP-BC
NPI 1053243659
Nurse Practitioner - Psychiatric/Mental Health in Salem, MA
Active since May 30, 2026
About Jordan Lynne Sidebottom Pmhnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JORDAN LYNNE SIDEBOTTOM PMHNP-BC (NPI 1053243659) is an individual psychiatric/mental health provider in Salem, Massachusetts, licensed in Massachusetts (RN2265344) and active in the NPI registry since May 2026.
NPPES Registry Identity
NPI1053243659
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameJORDAN LYNNE SIDEBOTTOMCredential: PMHNP-BC
Location Address19 BERTUCCIO AVESalem, MA 01970-2931
Mailing Address19 Bertuccio AveSalem, MA 01970-2931
Phone(617) 763-4464
Sole ProprietorNo
Enumeration DateMay 30, 2026
NPPES CertifiedMay 30, 2026
✔ NPI 1053243659 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in MA · RN2265344
19 BERTUCCIO AVE, Salem, MA 01970
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1053243659, enumerated as an "individual" on May 30, 2026.
The provider is located at 19 BERTUCCIO AVE SALEM, MA 01970 and the phone number is (617) 763-4464.
Nurse Practitioner with taxonomy code 363LP0808X and a focus in Psychiatric/Mental Health.
