Provider Demographics
NPI:1407302797
Name:BOUDREAUX, BLAIR (NP)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:DUPLESIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:15790 PAUL VEGA MD DRIVE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1434
Mailing Address - Country:US
Mailing Address - Phone:985-230-1360
Mailing Address - Fax:985-230-1361
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-1360
Practice Address - Fax:985-230-1361
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily