MEDICARE: JESSICA BOSCH BORDELON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP06791	LA
2	363LA2200X	Adult Health Nurse Practitioner	AP06791	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043585854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BOSCH BORDELON APRN

Provider Business Mailing Address
First Line	:	15799 PROFESSIONAL PLZ
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1452
Country	:	US
Telephone Number	:	985-419-0025
Fax Number	:	985-419-0035

Provider Business Practice Location Address
First Line	:	15799 PROFESSIONAL PLZ
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1452
Country	:	US
Telephone Number	:	985-419-0025
Fax Number	:	985-419-0035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	12/09/2025

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