MR. BRENT DAVID BOUDREAUX (NPI# 1548477573) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548477573 |
| Entity Type | Individual |
| Full Name | MR. BRENT DAVID BOUDREAUX |
| Credential | ATC |
| Practice Address |
104 Denette Dr Duson LA 70529-3750 |
| Practice Telephone | 3373443400 |
| Mailing Telephone | 3373443400 |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2017-05-02 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
J109 | LA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | LSBME | J109 | 01 |
| BOC | 069102490 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629367099 | Brent F Boudreaux | Pharmacist | 20901 E Smoky Hill Rd, Aurora, CO 80015-5184 | 2011-04-06 |
| 1467423913 | Brent Boudreaux | Radiology | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2006-01-31 |
| Street Address |
104 DENETTE DR |
| City | DUSON |
| State | LA |
| Zip Code | 70529-3750 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942798137 | Duson's Cashway Pharmacy | Pharmacy | 110 W. First Street Ste B, Duson, LA 70529 | 2018-04-24 |
| 1619342144 | Shawana Mouton | Counselor | 601 E St, Duson, LA 70529 | 2015-12-09 |
| 1356503759 | Sandra F Reiners | Licensed Practical Nurse | 9023 Cameron St, Duson, LA 70529 | 2008-06-26 |
| 1568645430 | Tiffany Smith Roy | Nurse Practitioner | 9023 Cameron St., Duson, LA 70529 | 2007-12-13 |
| 1720119761 | John Jerome Hernandez | Pharmacist | 9021 Cameron St, Duson, LA 70529 | 2007-03-09 |
| 1437229077 | Duson Rx, Inc. | Pharmacy | 9021 Cameron St., Duson, LA 70529 | 2006-11-09 |
| 1740293331 | Duson Mental Health Services LLC | Clinic/Center | 1450 Ridge Road, Duson, LA 70529 | 2006-08-14 |
| 1063076024 | Kayla Bergeaux | Nurse Practitioner | 110 W First St, Suite A, Duson, LA 70529 | 2019-04-25 |
| 1376986257 | Tiffany Roy Fnp LLC | Clinic/Center | 9023 Cameron St, Duson, LA 70529 | 2013-04-10 |
| 1699930719 | Tiffany Roy, Fnp, L.L.C. | Clinic/Center | 9023 Cameron St., Duson, LA 70529 | 2008-07-29 |
| Find all providers in zip 70529 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346848116 | Kerry Michael Ruiz | Specialist/Technologist | 2378 Kensington Dr, Baton Rouge, LA 70809-1210 | 2020-10-14 |
| 1013514710 | Jody Powell | Specialist/Technologist | 1600 Arizona Ave, Monroe, LA 71202-3602 | 2020-10-06 |
| 1336755495 | Kevin Keys | Specialist/Technologist | 106 Tomahawk Dr, Lafayette, LA 70503-6606 | 2020-09-23 |
| 1770199531 | Ryan Petrossi | Specialist/Technologist | 11959 Nicholson Dr Apt 17304, Baton Rouge, LA 70810-7626 | 2020-09-17 |
| 1285240028 | Cecilia Kieliszewski | Specialist/Technologist | 308 Warhawk Way Ulm Athletics Department, Monroe, LA 71209-0001 | 2020-09-17 |
| 1659985596 | Jake Bradley Lipps | Specialist/Technologist | 40068 Davis Dr, Ponchatoula, LA 70454-6410 | 2020-09-08 |
| 1942811773 | William Connor Sinclair | Specialist/Technologist | 12019 Fairview Way, Saint Francisville, LA 70775-7464 | 2020-08-14 |
| 1336750306 | Margaret Anne Schladenhauffen | Specialist/Technologist | 131 S Jeff Davis Pkwy Unit 100, New Orleans, LA 70119-6227 | 2020-08-13 |
| 1457962847 | Alexa Yanez | Specialist/Technologist | 936 Elmeer Ave, Metairie, LA 70005-1612 | 2020-08-11 |
| 1609486885 | Jasmine Joane Anderson | Specialist/Technologist | 1228 S Genois St, New Orleans, LA 70125-1724 | 2020-08-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.