| Doctor Name: | JESSICA BOEDEKER |
| NPI Number: | 1952771446 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | AP129156 |
| Business Practice Address: | 1001 Us Highway 83 N Childress, TX - 792012322 |
| Business Phone Number: | 9409373636 |
| Business Fax Number: | |
| Mailing Address: | Po Box 135, CHILDRESS |
| State: | TX |
| Postal Code: | 792010135 |
| Phone Number: | 2547167375 |
| Fax Number: | |
| NPI Enumeration Date: | 09/28/2015 |
| NPI Last Update Date: | 09/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP129156 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |