Organization · Type 2 NPI

Edie Boudreaux LLC

Multi-Specialty Clinic/Center · New Iberia, LA

NPI number 1457769358 Active

Practice location

124 E Main St Ste 104
New Iberia, LA 70560-3725

Call (337) 608-9922 Map

Fax (337) 608-9933

Mailing address

PO Box 9227
New Iberia, LA 70562-9227

Specialties and licenses

Taxonomy	Code	License
Registered Nurse	163W00000X	None listed
Nursing Care Agency	251J00000X	None listed
Multi-Specialty Clinic/Center Primary	261QM1300X	None listed
Point of Service	305S00000X	None listed
Nurse Practitioner	363L00000X	None listed
Family Nurse Practitioner	363LF0000X	None listed
Psychiatric/Mental Health Nurse Practitioner	363LP0808X	None listed

Multi-Specialty Clinic/Center: Definition to come...

NPI record

NPI: 1457769358
Entity type: Organization (Type 2)
Issued: Jul 24, 2014
Last updated: Sep 4, 2024
Status: Active
Subpart: Yes of Edie Boudreaux LLC

Other names

<unavail>
Edie B. Pourciau, NP · doing business as

Authorized official

Edie B Pourciau, PMHNP-BC, ANP-BC
Owner/nurse Practitioner
(337) 608-9922

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1457769358

Edie Boudreaux LLC's National Provider Identifier is 1457769358, issued on Jul 24, 2014. The primary taxonomy on file is Multi-Specialty Clinic/Center (261QM1300X), and the practice location is in New Iberia, LA. The record was last updated on Sep 4, 2024.