Edie Boudreaux LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

EDIE BOUDREAUX LLC

Practice address

124 E Main St Ste 104
New Iberia, LA 70560-3725

Phone

(337) 608-9922

Fax

(337) 608-9933

NPI assigned

Jul 24, 2014

Organization subpart

Yes

Parent organization

EDIE BOUDREAUX LLCAs reported in NPPES

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

Authorized official

Name

Edie B Pourciau, PMHNP-BC, ANP-BCNPI 1659557940

Title

Owner/Nurse Practitioner

Phone

(337) 608-9922

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 1

• EDIE B. POURCIAU, NP Doing business as

Part of

Edie Boudreaux LLC

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edie B Pourciau, ANP-BC,PMHNP-BC

  • Adult Health Nurse Practitioner
  • Lafayette, LA
  • NPI 1659557940

  Registered Nurse

  NPD Authorized official
• Stephanie C Badon, APRN-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • New Iberia, LA
  • NPI 1649936956

  Nurse Practitioner

  NPD

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

{
    "created_epoch": "1406160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1457769358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9227",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705629227",
            "telephone_number": "337-608-9922",
            "fax_number": "337-608-9933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E MAIN ST STE 104",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705603725",
            "telephone_number": "337-608-9922",
            "fax_number": "337-608-9933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDIE BOUDREAUX LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDIE BOUDREAUX LLC",
        "enumeration_date": "2014-07-24",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "POURCIAU",
        "authorized_official_first_name": "EDIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/NURSE PRACTITIONER",
        "authorized_official_telephone_number": "337-608-9922",
        "authorized_official_credential": "PMHNP-BC, ANP-BC"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1309877",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDIE B. POURCIAU, NP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in New Iberia, LA
• Multi-Specialty Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; 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.