Basic Information
| Provider Information | |||||||||
| NPI: | 1881605996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOEVERS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | E | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 NW 7TH ST | ||||||||
| Address2: | |||||||||
| City: | POCAHONTAS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505741000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123355632 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 608 NW 7TH ST | ||||||||
| Address2: | |||||||||
| City: | POCAHONTAS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505741000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123355632 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3292 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 42231 | 01 | IA | WELLMARK | OTHER | 0242925 | 05 | IA | MEDICAID |