Provider Demographics
NPI:1649880543
Name:BOUTWELL, ALLISON JOY (PA-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:JOY
Last Name:BOUTWELL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:JOY
Other - Last Name:FINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-264-6000
Mailing Address - Fax:
Practice Address - Street 1:50 PARKWAY LN STE 10
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465
Practice Address - Country:US
Practice Address - Phone:601-544-7404
Practice Address - Fax:601-584-6457
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant