JEFFERSON L BOULET (NPI# 1740274745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740274745 |
| Entity Type | Individual |
| Full Name | JEFFERSON L BOULET |
| Credential | PAC |
| Practice Address |
305 N River Ave Buckley WA 98321-8978 |
| Mailing Address |
Po Box 1268 Buckley WA 98321-1268 |
| Practice Telephone | 3608290625 |
| Practice Fax Number | 3608299860 |
| Mailing Telephone | 3608290625 |
| Mailing Fax Number | 3608299860 |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2008-03-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA10003567 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | DEA | MB0292160 | 01 |
| WA | 8542300 | 05 |
| Street Address |
305 N RIVER AVE |
| City | BUCKLEY |
| State | WA |
| Zip Code | 98321-8978 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235122763 | Michael A Welsh | Family Medicine | 305 N River Ave, Buckley, WA 98321-8978 | 2005-08-30 |
| 1649263161 | James L Parker | Family Medicine | 305 N River Ave, Buckley, WA 98321-8978 | 2005-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598308397 | Melanie Tison | Licensed Practical Nurse | 340 White River Park Rd, Buckley, WA 98321 | 2019-10-24 |
| 1164918850 | Desiree Helfrick | Counselor | 117 S Cedar St, Suite 2, Buckley, WA 98321 | 2018-07-05 |
| 1962925206 | Karen Anne Smith | Counselor | 240 A St. N, Buckley, WA 98321 | 2017-07-19 |
| 1992227375 | Clb Pharmaceutical Resources Inc | Public Health or Welfare | 22712 78th St. E, Buckley, WA 98321 | 2017-07-07 |
| 1922547231 | Kathryn Zawislak | Counselor | 117 S Cedar St, Suite 2, Buckley, WA 98321 | 2017-02-20 |
| 1336525443 | Jennifer Cochrane-nicolls | Social Worker | 117 S. Cedar St., Suite 2, Buckley, WA 98321 | 2015-07-31 |
| 1427399013 | Karis Ann Roberts | Occupational Therapy Assistant | 130 S Cottage St, Buckley, WA 98321 | 2013-03-07 |
| 1235495433 | Michael Leigh Beall | Chiropractor | 766 Main St, Buckley, WA 98321 | 2012-04-02 |
| 1720395601 | Jared Stephen Bleasdale | Massage Therapist | 280 C Street, Buckley, WA 98321 | 2010-09-13 |
| 1164630620 | Sandra T Bittner | Massage Therapist | 700 Main St P, Buckley, WA 98321 | 2007-05-18 |
| Find all providers in zip 98321 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033735618 | Gavin Guard | Physician Assistant | 818 Mullis St Ste 6, Friday Harbor, WA 98250-7986 | 2020-06-19 |
| 1578110862 | Kaitlin E. Brotman | Physician Assistant | 315 Holton Ave Ste 100, Yakima, WA 98902-3245 | 2019-08-21 |
| 1700345196 | Kara Lynn Kime | Physician Assistant | 1200 Cooper Point Rd Sw Ste 100, Olympia, WA 98502-1172 | 2019-03-15 |
| 1679056824 | Katharine Loco-marshall | Physician Assistant | 4816 She-nah-num Drive, Olympia, WA 98513 | 2018-09-13 |
| 1841791274 | Sjs, Pllc | Physician Assistant | 900 Ocean Beach Hwy Ste B, Longview, WA 98632-4013 | 2018-02-21 |
| 1063928448 | Heidi April | Physician Assistant | 1410 N Pittsburgh St, Building A, Kennewick, WA 99336-8211 | 2017-12-20 |
| 1194251983 | Christopher Joseph Stanley | Physician Assistant | 1010 Ne Lilac St Apt 301, Issaquah, WA 98029-7878 | 2017-05-11 |
| 1366993362 | Vanessa Julie Iglesias Mehta | Physician Assistant | 5128 Yelm Hwy Se, Suite E, Lacey, WA 98503 | 2016-10-14 |
| 1801344601 | Jessica Ann Pettitt | Physician Assistant | 21200 Ne 190th Ct, Battle Ground, WA 98604-9636 | 2016-09-21 |
| 1407300098 | Joshua David Evans | Physician Assistant | 9040 Jackson Ave Mchj Clq C, Tacoma, WA 98431-1100 | 2016-08-11 |
| Find all providers with the same taxonomy | ||||
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| 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.