Provider Demographics
NPI:1033465380
Name:BOUDREAUX, GAYLE K (RD, LDN)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:K
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W PORT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-3923
Mailing Address - Country:US
Mailing Address - Phone:337-394-3097
Mailing Address - Fax:337-394-1279
Practice Address - Street 1:303 W PORT ST
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-3923
Practice Address - Country:US
Practice Address - Phone:337-394-3097
Practice Address - Fax:337-394-1279
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1279133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist