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General NPI Number Information
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NPI Number | 1306752811
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Entity Type | Individual
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Provider Name | JESSICA LYNN BOETTCHER PA
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Gender | Female
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | PO BOX 1090
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City | BUIES CREEK
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State | NC
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Zip | 27506-1090
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Country | US
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Telephone | 910-893-1690
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Fax |
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Provider Business Mailing Address
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Address Line | 3040 N KILCHATTAN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-4653
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Country | US
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Telephone | 920-634-7133
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NC
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