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General NPI Number Information
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NPI Number | 1609756469
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Entity Type | Individual
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Provider Name | JESSIE LYN BOUCHARD MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 593 EDDY ST HASBRO LOWER LEVEL
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City | PROVIDENCE
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State | RI
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Zip | 02903-4923
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Country | US
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Telephone | 401-444-6195
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Fax | 401-444-6378
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Provider Business Mailing Address
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Address Line | 15 LA SALLE SQ
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City | PROVIDENCE
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State | RI
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Zip | 02903-1814
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Country | US
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Telephone | 401-444-6779
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Fax | 401-444-6912
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN04714
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | APRN04714
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License Number State | RI
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