Individual
JAMES BRYCE BOUDREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 E BROADWAY, COLUMBIA, MO 65201-5844
(573) 815-8000
Mailing address
1600 E BROADWAY, COLUMBIA, MO 65201-5844
(573) 815-8000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2022013516
MO
363LF0000X
Family Nurse Practitioner
Primary
2022021020
MO
363LP2300X
Primary Care Nurse Practitioner
2018007575
MO
Other
Enumeration date
05/26/2022
Last updated
06/13/2022
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