Individual
DR. SHEILA BOULDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
15149
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120467
—
MS
01
—
08103071
UP MEDICAID GROUP NUMBER
MS
01
—
160056544
RR MEDICARE NUMBER
MS
05
—
178135
—
MS
01
—
512G700003
UP MEDICARE GROUP PROV #
MS
01
—
512I160015
MEDICARE PTAN
MS
Enumeration date
06/18/2006
Last updated
11/12/2015
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