Individual
KAITLYN WINNIE CARROLL BOUQUET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
6550 MAIN ST STE 2300, ZACHARY, LA 70791-4092
(225) 658-1808
(225) 658-5922
Mailing address
8080 BLUEBONNET BLVD STE 1000, BATON ROUGE, LA 70810-7827
(225) 924-2424
(225) 408-7980
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
328192
LA
Other
Enumeration date
08/03/2021
Last updated
07/30/2024
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