Healthcare Provider Details

I. General information

NPI: 1114830841
Provider Name (Legal Business Name): YESSIKA BOADA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 W NORTH HILL DR
SPRING TX
77388-8915
US

IV. Provider business mailing address

519 W NORTH HILL DR
SPRING TX
77388-8915
US

V. Phone/Fax

Practice location:
  • Phone: 832-888-0075
  • Fax:
Mailing address:
  • Phone: 832-888-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1195424
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1195424
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1195424
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: