Jennifer Katharine Boudreaux, MSN, CPNP-PC, PMHS

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

201350098NP Issued in OR

Practice address

33 N Central Ave Ste 317
Medford, OR 97501-5939

Phone

(541) 227-2808

Fax

(541) 227-2807

NPI assigned

Oct 18, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Master of Science - Nursing, Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25687/brand/6/csg/1/fhir/r4
• Direct secure messaging: jennifer.k.boudreaux@jkbcpl-or.direct.office.nextgen.com
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• Direct secure messaging: jboudreaux392402@oc.providencedirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Neurodevelopmental & Behavioral Clinic of Southern Oregon

  • Community/Behavioral Health Agency
  • Medford, OR
  • NPI 1619791415
  NPD Authorized official
• Rivera Health & Wellness

  • Medical Specialty Clinic/Center
  • Medford, OR
  • NPI 1477344802
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1790038495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CHERRYBARK DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285409360",
            "telephone_number": "541-324-3648",
            "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": {
        "last_name": "BOUDREAUX",
        "first_name": "JENNIFER",
        "middle_name": "KATHARINE",
        "credential": "MSN, CPNP-PC, PMHS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-18",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201350098NP",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OR",
            "license": "201350098NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500657026",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Louise Botello
• Keyan Botsford, DMD, MSD
• Cindy Marie Bottasso, DO
• Sarah Katherine Bottomly-Cox
• Janeice K Bouchard
• Christopher Brice Bouffard, PA-C
• Lydia Bouman
• Melissa Jean Bouse
• Alice Bowen, PT
• Kathy Bowlin, PT

• Pediatric Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Pediatric Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.