Individual
KELLY EATON BOUSSERT
Active
Individual
KELLY EATON BOUSSERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD.207144
LA
208VP0014X
Interventional Pain Medicine Physician
Primary
MD.207144
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1883450
—
LA
Enumeration date
04/28/2009
Last updated
06/15/2021
Update your record
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