Basic Information
| Provider Information | |||||||||
| NPI: | 1427381599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUDREAUX | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1542 TULANE AVE. | ||||||||
| Address2: | LSUHSC DEPT OF PSYCHIATRY ROOM 233 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045687912 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1542 TULANE AVE. | ||||||||
| Address2: | LSUHSC DEPT. OF PSYCHIATRY ROOM 233 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701120000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045687912 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2009 | ||||||||
| LastUpdateDate: | 03/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | UO2160 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | LA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.