Provider Demographics
NPI:1770264608
Name:BOUILLION, MARCY LEA (APRN, FNP)
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:LEA
Last Name:BOUILLION
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3634 COTTAGE PINES LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4500
Mailing Address - Country:US
Mailing Address - Phone:936-689-3151
Mailing Address - Fax:
Practice Address - Street 1:13725 FALBA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3810
Practice Address - Country:US
Practice Address - Phone:281-206-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner