Individual
JESSIE LYN BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-C
Contact information
Practice address
701 GEORGE WASHINGTON HWY STE 104, LINCOLN, RI 02865-4299
(401) 606-8052
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
APRN04714
RI
363L00000X
Nurse Practitioner
Primary
APRN04714
RI
Other
Enumeration date
09/03/2025
Last updated
01/23/2026
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