Organization
ADVANCED PAIN MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY EATON BOUSSERT (MEMBER)
(318) 278-4292
Entity
Organization
Contact information
Practice address
6536 LASALLE AVE, BATON ROUGE, LA 70806-7318
(318) 278-4292
Mailing address
6536 LASALLE AVE, BATON ROUGE, LA 70806-7318
(318) 278-4292
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
11/28/2017
Last updated
11/28/2017
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