Provider Demographics
NPI:1184458846
Name:BOUDREAUX, ANNA CATHERINE (PA)
Entity type:Individual
Prefix:
First Name:ANNA CATHERINE
Middle Name:
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1013
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1013
Mailing Address - Country:US
Mailing Address - Phone:662-234-1448
Mailing Address - Fax:662-234-5374
Practice Address - Street 1:2168 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5224
Practice Address - Country:US
Practice Address - Phone:662-234-1448
Practice Address - Fax:662-234-5374
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant