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EDIE BOUDREAUX LLC NPI 1457769358


NPI Information

NPI: 1457769358
Provider Name: EDIE BOUDREAUX LLC

Doing Business As: EDIE B. POURCIAU, NP

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 19D2124980

Address:
124 E MAIN ST STE 104
NEW IBERIA, LA
ZIP 70560
Phone: (337) 608-9922
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EDIE BOUDREAUX LLC is a multi-specialty clinic center in New Iberia, LA. EDIE BOUDREAUX LLC NPI is 1457769358. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Edie B. Pourciau, Np.

The provider's business location address is:

124 E MAIN ST STE 104
NEW IBERIA, LA
ZIP 70560-725
Phone: (337) 608-9922
Fax: (337) 608-9933

The provider's authorized official is Edie B Pourciau .
The authorized official title is Owner/nurse Practitioner and has the following contact phone number (337) 608-9922.

The CLIA number assigned to this NPI record is 19D2124980 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/24/2014 and was last updated on 12/16/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163W00000XRegistered NurseNo
2251J00000XNursing CareNo
3261QM1300XClinic/CenterMulti-SpecialtyYes
4305S00000XPoint of ServiceNo
5363L00000XNurse PractitionerNo
6363LF0000XNurse PractitionerFamilyNo
7363LP0808XNurse PractitionerPsychiatric/Mental HealthNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11309877MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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