Individual
JEFFERSON L BOULET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
305 N RIVER AVE, BUCKLEY, WA 98321-8978
(360) 829-0625
(360) 829-9860
Mailing address
PO BOX 1268, BUCKLEY, WA 98321-1268
(360) 829-0625
(360) 829-9860
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10003567
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8542300
—
WA
Enumeration date
09/06/2005
Last updated
03/07/2023
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