Tara Boudoin Deville, NP
Individual provider Active NPI Nurse Practitioner · Beaumont, TX
NPI 1104184845 · NPPES record last updated Jun 13, 2018
Key facts
- NPI
- 1104184845
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 712309 (TX)
- Practice address
- 3195 Dowlen Rd Ste 105
Beaumont, TX 77706 - Phone
- (409) 204-0257
- NPI assigned
- May 1, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120813000556 | TX | Practitioner - Nurse Practitioner | 3971759689 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Doctors Express of the Beaumont Area PA | Current |
Accepting new patients | |
| Doctor on Demand Professionals P C | Current |
Accepting new patients | |
| Southlake Doctors Express, PA PSC | Current | Accepting new patients | |
| Jefferson Emergency Medicine Associates PA | Nurse Practitioner | Past | Accepting new patients |
Locations
1 California St
Ste 2300
San Francisco, CA 94111
Phone (800) 929-0926
275 Battery St
Ste 650
San Francisco, CA 94111
Phone 4155043838104
211 E 7th St
Ste 620
Austin, TX 78701
Phone (415) 742-8411
8831 N Highway 146
Baytown, TX 77523
Phone (281) 533-8354
3195 Dowlen Rd
Ste 105
Beaumont, TX 77706
Phone (409) 860-1888
15236 Wallisville Rd
Houston, TX 77049
Phone (281) 862-8955
6445 FM 1463 Rd
Ste 230
Katy, TX 77494
Phone (281) 990-6890
8850 Spencer Hwy
La Porte, TX 77571
Phone (281) 946-9980
2315 E Southlake Blvd
Ste 110
Southlake, TX 76092
Phone (817) 488-9922
Interoperability endpoints
- tara.deville.1@30520.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 712309 | TX | Yes |
Addresses
Primary practice location
3195 Dowlen Rd Ste 105
Beaumont, TX 77706
Mailing address
3195 Dowlen Rd Ste 105
Beaumont, TX 77706-7272
Phone (409) 204-0257
Other providers in Beaumont, TX
- Developmental Disabilities Management Services of Beaumont, LLC
- Developmental Disabilities Management Services of Beaumont, LLC
- Developmental Disabilities Management Services of Beaumont, LLC
- Developmental Disabilities Management Services of Beaumont, LLC
- Sunita Devi
- Cassandra Covington Dewall
- Gurpartap Dhillon
- Diagnostic & Internal Medicine Clinic PA
- Diagnostic Group Imaging PLLC
- Diagnostic Group Integrated Healthcare System PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.