Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jacqueline Anne Boulris, PA-C

Individual provider Medical Physician Assistant · NPI 1639937154

Jacqueline Anne Boulris, PA-C is a Physician Assistant in Reston, Virginia. Qualified in 2023, 3 years ago. Licensed in Virginia.

Years since qualifying
3
Licensed in
VA
In the registry since
2024
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1860 Town Center Dr Ste 240
Reston, VA 20190-5899
Phone: (703) 796-1986
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 0110009803 (VA)

Record details

NPI number1639937154
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 11, 2024
Last updated in NPPESFebruary 21, 2025
Certification dateFebruary 21, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated

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