Lisa Boudreaux Mimnagh
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Gray, LA
NPI 1063950285 · NPPES record last updated Feb 8, 2017
Key facts
- NPI
- 1063950285
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- AP09186 (LA)
- Practice address
- 151 Gainesville Dr
Gray, LA 70359-4525 - Phone
- (985) 790-2568
- NPI assigned
- Feb 8, 2017
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP09186 | LA | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | AP09186 | LA | Yes |
Addresses
Primary practice location
151 Gainesville Dr
Gray, LA 70359-4525
Mailing address
151 Gainesville Dr
Gray, LA 70359-4525
Phone (985) 790-2568
Other names
- Lisa Anne Boudreaux
Other providers in Gray, LA
- Chelcie Malbrue
- Courtney Hawkins Malveaux
- Melissa G Marcombe
- Sierra McKay
- Mental Wellness 4U, LLC
- Glenn Louis Naquin Jr.
- Jeanette L Naquin
- Leshecca Norman
- Paige Pipsair
- Jimmy Nolan Ponder Jr.
All providers in Gray, LA · Psychiatric/Mental Health Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 8, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.