Provider Demographics
NPI:1205409117
Name:BOAZ, JESSICA (PA)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:BOAZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:BOAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:7234 TAZEWELL PIKE
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-3550
Mailing Address - Country:US
Mailing Address - Phone:865-213-7132
Mailing Address - Fax:865-213-7133
Practice Address - Street 1:7234 TAZEWELL PIKE
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-3550
Practice Address - Country:US
Practice Address - Phone:865-213-7132
Practice Address - Fax:865-213-7133
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000004527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant