Renella Boullion, APRN, FNP-BC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP145643 Issued in TX

Practice address

400 Ogletree Dr
Livingston, TX 77351-6783

Phone

(936) 328-8812

NPI assigned

Mar 23, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1003442906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 OGLETREE DR",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773516783",
            "telephone_number": "936-328-8812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 OGLETREE DR",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773516783",
            "telephone_number": "936-328-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULLION",
        "first_name": "RENELLA",
        "credential": "APRN, FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-23",
        "last_updated": "2022-07-14",
        "certification_date": "2022-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "AP145643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AP145643",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE",
            "identifier": "AP145643",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ONALASKA",
            "affiliation": "N",
            "endpointDescription": "secure service",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "674 May Dr",
            "city": "Onalaska",
            "state": "TX",
            "country_code": "US",
            "postal_code": "773605169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pediatric Nurse Practitioner in Livingston, TX
• Providers in Livingston, TX by specialty
• Pediatric Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.