Basic Information
| Provider Information | |||||||||
| NPI: | 1285809640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | HENDERSON | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HENDERSON | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 NEW JERSEY AVE SE STE 500 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200033326 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 NEW JERSEY AVE SE STE 500 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200033326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024694699 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2008 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD042863 | DC | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2003013131 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0214X | 2003013131 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | 208000000X | D69298 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.