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Organization

EDIE BOUDREAUX LLC

Active
Parent organization
EDIE BOUDREAUX LLC
Other names
EDIE B. POURCIAU, NP
Organization subpart
Yes

Provider details

NPI number
Legal business name
EDIE BOUDREAUX LLC
Authorized official
EDIE B POURCIAU PMHNP-BC, ANP-BC (OWNER/NURSE PRACTITIONER)
(337) 608-9922
Entity
Organization

Contact information

Practice address
124 E MAIN ST STE 104, NEW IBERIA, LA 70560-3725
(337) 608-9922
(337) 608-9933
Mailing address
PO BOX 9227, NEW IBERIA, LA 70562-9227
(337) 608-9922
(337) 608-9933

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
251J00000X
Nursing Care Agency
261QM1300X
Multi-Specialty Clinic/Center
Primary
305S00000X
Point of Service
363L00000X
Nurse Practitioner
363LF0000X
Family Nurse Practitioner
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1309877
LA
Enumeration date
07/24/2014
Last updated
09/04/2024
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