MEDICARE: NATHANIEL BODDY

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	363AM0700X	Medical Physician Assistant	PA65188	CA

General Provider Information

NPI Number	:	1881390854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL BODDY

Provider Business Mailing Address
First Line	:	1413 SPRUCE AVE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-3479
Country	:	US
Telephone Number	:	971-219-8279
Fax Number	:

Provider Business Practice Location Address
First Line	:	ENTER AT W. FIFTH AND 1531 ESPLANADE, MAGNOLIA AVE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926
Country	:	US
Telephone Number	:	971-219-8279
Fax Number	:

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

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	06/02/2026

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Directions to “ NATHANIEL BODDY ” Practice Location

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