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Individual
STACI SIMON BOUDREAUX
Active
Individual
STACI SIMON BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-10929
NC
363A00000X
Physician Assistant
PAA10607 RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026867
—
LA
Enumeration date
09/20/2005
Last updated
05/05/2025
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