Provider Demographics
NPI:1376592055
Name:BOUDREAUX, KRISTIN LUCAS (DC, MSN, APRN)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LUCAS
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:DC, MSN, APRN
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:COLLEEN
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 JEAN MAR RD
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-7544
Mailing Address - Country:US
Mailing Address - Phone:337-298-3290
Mailing Address - Fax:
Practice Address - Street 1:203 WESTGATE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2712
Practice Address - Country:US
Practice Address - Phone:337-223-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily