Healthcare Provider Details

I. General information

NPI: 1306752811
Provider Name (Legal Business Name): JESSICA LYNN BOETTCHER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1090
BUIES CREEK NC
27506-1090
US

IV. Provider business mailing address

3040 N KILCHATTAN DR
FAYETTEVILLE NC
28306-4653
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-1690
  • Fax:
Mailing address:
  • Phone: 920-634-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: