Active NPI
Amy Boudonck
- Registered Nurse
- East Saint Louis, IL
National Provider Identifier
1295385888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 2008023288
- Practice address
- 1406 N 39TH St
East Saint Louis, IL 62204-2431 - Phone
- (314) 482-3706
- NPI assigned
- Sep 16, 2019
- Last updated
- Sep 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2008023288 | MO | Primary |
Addresses
Primary practice location
1406 N 39TH St
East Saint Louis, IL 62204-2431
Mailing address
16544 Hunters Crossing Dr
Wildwood, MO 63040-1733
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Amymr124@yahoo.com |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2008023288 | MO | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568592000000",
"number": "1295385888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16544 HUNTERS CROSSING DR",
"city": "WILDWOOD",
"state": "MO",
"postal_code": "630401733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1406 N 39TH ST",
"city": "EAST SAINT LOUIS",
"state": "IL",
"postal_code": "622042431",
"telephone_number": "314-482-3706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDONCK",
"first_name": "AMY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-16",
"last_updated": "2019-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MO",
"license": "2008023288",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Amymr124@yahoo.com",
"affiliation": "N",
"address_1": "1406 N 39th St",
"city": "East Saint Louis",
"state": "IL",
"country_code": "US",
"postal_code": "622042431",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in East Saint Louis, IL
- Estelisa Bevely, RN
- Clydie Blackwell, RN
- Board of Trustees of Southern Illinois University (Southern Illinois University Edwardsville)
- Karen D Boide, PTA
- Carolyn M. Booth, PA
- Bright Ideas for a Better Tomorrow
- Frank Daniel Buono, MS
- Rita Lemons Byrd, LCSW
- C & T Transportation Services Corp.
- Call for Help, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.