Individual
JENNIFER KATHARINE BOUDREAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, CPNP-PC, PMHS
Contact information
Practice address
33 N CENTRAL AVE STE 317, MEDFORD, OR 97501-5939
(541) 227-2808
(541) 227-2807
Mailing address
104 CHERRYBARK DR, JACKSONVILLE, NC 28540-9360
(541) 324-3648
(541) 227-2807
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
201350098NP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
201350098NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500657026
—
OR
Enumeration date
10/18/2012
Last updated
11/28/2023
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