Individual
MRS. ALICIA BOUDREAUX KEENHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
124 MALLARD ST, GREENVILLE, SC 29601
(864) 241-1040
Mailing address
124 MALLARD ST, GREENVILLE, SC 29601-4046
(864) 241-1040
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
115451
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115451
NURSING
LA
Enumeration date
01/31/2007
Last updated
08/16/2018
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