Jessica Brooke Bouldin, PHARMD

Primary specialty

Ambulatory Care PharmacistTaxonomy code 1835P2201X

License

44395 Issued in TN

Practice address

483 W Bockman Way
Sparta, TN 38583-1832

Phone

(931) 836-3230

NPI assigned

Jan 20, 2021

Last updated

Jan 20, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

Practice roles

Locations

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

• Walgreen Co

  dba Walgreens #10815

  • Pharmacy
  • Sparta, TN
  • NPI 1649489089
  NPD
• Walgreen Co

  dba Walgreens #21605

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1881284206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 GOLF CLUB RD",
            "city": "MCMINNVILLE",
            "state": "TN",
            "postal_code": "371107838",
            "telephone_number": "931-314-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 W BOCKMAN WAY",
            "city": "SPARTA",
            "state": "TN",
            "postal_code": "385831832",
            "telephone_number": "931-836-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDIN",
        "first_name": "JESSICA",
        "middle_name": "BROOKE",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "TN",
            "license": "44395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF TENNESSEE",
            "identifier": "44395",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Birch Tree Pediatric Therapy, PLLC (Playful Learning)
• Heather Blaney
• Maranda Darline Blaylock, RBT
• Gregory L. Boston, D.D.S.
• Botanical Emergency Physicians, LLC
• James Patrick Bowen, PT
• Laina Marguerite Bowen, P.T.
• Daniel Briggs Boyd, PHARMD
• Celisity Bradley
• Bridgeway Counseling

• Ambulatory Care Pharmacist in Sparta, TN
• Providers in Sparta, TN by specialty
• Ambulatory Care Pharmacist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.