Individual
CARLY BOURGEOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6300 MAIN ST, ZACHARY, LA 70791-4037
(225) 765-7163
Mailing address
6300 MAIN ST, ZACHARY, LA 70791-4037
(225) 765-7163
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
328269
LA
Other
Enumeration date
08/02/2021
Last updated
08/02/2021
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