Active NPI
Pediatric Neurodevelopmental & Behavioral Clinic of Southern Oregon
- Community/Behavioral Health Agency
- Medford, OR
National Provider Identifier
1619791415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- PEDIATRIC NEURODEVELOPMENTAL & BEHAVIORAL CLINIC OF SOUTHERN OREGON
- Practice address
- 33 N Central Ave Ste 317
Medford, OR 97501-5939 - Phone
- (541) 227-2808
- Fax
- (541) 227-2807
- NPI assigned
- Nov 9, 2024
- Organization subpart
- Yes
- Parent organization
- JENNIFER K BOUDREAUX, CPNP, PMHS, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jennifer Boudreaux, MSN, CPNP, PMHS
- Title
- Owner/Provider
- Phone
- (541) 324-3648
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
33 N Central Ave Ste 317
Medford, OR 97501-5939
Mailing address
33 N Central Ave Ste 317
Medford, OR 97501-5939
Phone (541) 227-2808
National Provider Directory
National Provider Directory- Part of
- Pediatric Neurodevelopmental Behavioral Clinic of Southern Oregon
Interoperability endpoints
- https://api.platform.athenahealth.com/25687/brand/6/csg/1/fhir/r4
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pediatric Nurse Practitioner
- Medford, OR
- NPI 1790038495
-
- Nurse Practitioner
- Medford, OR
- NPI 1356977144
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731110400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1731110400000",
"number": "1619791415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 N CENTRAL AVE STE 317",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975015939",
"telephone_number": "541-227-2808",
"fax_number": "541-227-2807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 N CENTRAL AVE STE 317",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975015939",
"telephone_number": "541-227-2808",
"fax_number": "541-227-2807"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEDIATRIC NEURODEVELOPMENTAL & BEHAVIORAL CLINIC OF SOUTHERN OREGON",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "JENNIFER K BOUDREAUX, CPNP, PMHS, LLC",
"enumeration_date": "2024-11-09",
"last_updated": "2024-11-09",
"certification_date": "2024-11-08",
"status": "A",
"authorized_official_last_name": "BOUDREAUX",
"authorized_official_first_name": "JENNIFER",
"authorized_official_title_or_position": "OWNER/PROVIDER",
"authorized_official_telephone_number": "541-324-3648",
"authorized_official_credential": "MSN, CPNP, PMHS"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.