MRS. JESSICA FAYE BOUCHARD (NPI# 1023247608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023247608 |
| Entity Type | Individual |
| Full Name | MRS. JESSICA FAYE BOUCHARD |
| Credential | RPA-C |
| Practice Address |
4110 Medical Center Dr Fayetteville NY 13066-6613 |
| Practice Telephone | 3156630100 |
| Practice Fax Number | 3156630052 |
| Mailing Telephone | 3156630100 |
| Enumeration Date | 2009-07-05 |
| Last Update Date | 2014-11-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
013312-1 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376932285 | Jessica Bouchard | Dietitian, Registered | 2855 N Speer Blvd Ste B, Denver, CO 80211-4240 | 2015-01-15 |
| Street Address |
4110 MEDICAL CENTER DR |
| City | FAYETTEVILLE |
| State | NY |
| Zip Code | 13066-6613 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376537308 | Vadjista Broumand | Internal Medicine | 4110 Medical Center Dr, Suite 110, Fayetteville, NY 13066 | 2005-09-06 |
| 1336510916 | Melissa Roe | Physician Assistant | 4110 Medical Center Dr, Fayetteville, NY 13066-6613 | 2015-10-08 |
| 1871848481 | Meghan L Doran | Nurse Practitioner | 4110 Medical Center Dr, Suite 100, Fayetteville, NY 13066-6613 | 2012-07-19 |
| 1558507251 | Rachel Marie Damon | Physician Assistant | 4110 Medical Center Dr, Fayetteville, NY 13066-6613 | 2008-12-30 |
| 1336235639 | Dermatology Associates of Central New York Pllc | Dermatology | 4110 Medical Center Dr, Fayetteville, NY 13066-6613 | 2006-10-05 |
| 1992756209 | Ellen E Powers | Nurse Practitioner | 4110 Medical Center Dr, Fayetteville, NY 13066-6613 | 2006-05-12 |
| 1215991005 | Amin Fazeli | Dermatology | 4110 Medical Center Dr, Suite 110, Fayetteville, NY 13066-6613 | 2006-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457819963 | Word Wellness Center, LLC | Psychologist | 6836 E Genesee Street, Suite A, Fayetteville, NY 13066 | 2019-03-05 |
| 1629529060 | Lorna Boyer Chase | Marriage & Family Therapist | 109 White Heron Circle, Fayetteville, NY 13066 | 2016-10-20 |
| 1699221432 | Roman Batyuk | Nurse Practitioner | 4100 Medical Center Drive, Fayetteville, NY 13066 | 2016-08-31 |
| 1427405133 | National Eye Care, Inc | Optometrist | 5160 Kinloch Circle, Fayetteville, NY 13066 | 2016-05-23 |
| 1013375328 | Kristin Kukenberger | Chiropractor | 7000 E Genesee St Bldg B, Fayetteville, NY 13066 | 2016-02-01 |
| 1124394671 | Susan Hartman Brenizer | Marriage & Family Therapist | 7000 E Genesee St Lyndon Office Park, Bldg. A, Second Floor (upper Level), Fayetteville, NY 13066 | 2012-03-29 |
| 1245541432 | Rene L Converse | Occupational Therapist | 7200 E. Genesee Street, Fayetteville, NY 13066 | 2010-06-23 |
| 1689815805 | Menorah Park Group Residents | Clinic/Center | 12 Jamar Drive, Dewitt, NY 13066 | 2009-03-18 |
| 1063677458 | John Marcena Glezen | Obstetrics & Gynecology | 1 The Gazebo, Fayetteville, NY 13066 | 2008-07-24 |
| 1629232418 | Tucker Martin Harris | Otolaryngology | 4000 Medical Center Dr # 117, Fayetteville, NY 13066 | 2008-07-11 |
| Find all providers in zip 13066 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245860618 | Robert Maughan | Physician Assistant | 129 Bryce Creek Ln, Fayetteville, NC 28303-4981 | 2020-01-24 |
| 1578050480 | Marlee Anne Fallon | Physician Assistant | 4402 Medical Center Dr Ste 402, Fayetteville, NY 13066-6626 | 2018-04-16 |
| 1285149781 | Rebecca Anderson | Physician Assistant | 413 Owen Dr Ste 201, Fayetteville, NC 28304-3490 | 2017-12-06 |
| 1750807186 | Julia Niemi | Physician Assistant | 2409 Murchison Rd # B, Fayetteville, NC 28301-3519 | 2017-08-17 |
| 1548709991 | Pallavi Annamaneni | Physician Assistant | 2149 Valleygate Dr Ste 102, Fayetteville, NC 28304-3666 | 2017-02-17 |
| 1124457650 | Amanda Warden | Physician Assistant | 89 Cowley Hollow Rd, Fayetteville, TN 37334-6947 | 2013-11-05 |
| 1639473739 | Andrea Bethauser | Physician Assistant | 918 Hope Mills Rd, Fayetteville, NC 28304-4243 | 2011-01-04 |
| 1891928941 | Gladys Maria Rivero | Physician Assistant | 3450 Sandystone Cir, Fayetteville, NC 28311-2503 | 2009-08-24 |
| 1366524092 | Lisa Aldrin Rojeski | Physician Assistant | 4038 N Remington Dr, Suite 4, Fayetteville, AR 72703-6345 | 2006-10-20 |
| 1902829039 | Michael John Winn | Physician Assistant | 5511 Raeford Road, Suite 150, Fayetteville, NC 28304-2058 | 2006-07-26 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 13066 |
Please comment or provide details below to improve the information on MRS. JESSICA FAYE BOUCHARD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.