# DR. RENEE L BOULICAULT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1639148422
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 103629 | MO | — |
| 207V00000X | Obstetrics & Gynecology Physician | 4868-320 | WI | — |
| 207V00000X | Obstetrics & Gynecology Physician | 70768 | TN | — |
| 208M00000X | Hospitalist Physician | 70768 | TN | Yes |

## Other

- **Enumeration date:** 03/15/2006
- **Last updated:** 09/05/2025