Kristi McDonald Boudreaux, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5018585 Issued in NC

Practice address

154 Government Center Dr
Mocksville, NC 27028-6299

Phone

(336) 477-2233

Fax

(336) 450-1744

NPI assigned

Jul 20, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gaston Family Health Services Inc 98 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Iredell Memorial Hospital Inc Hospital, Statesville, NC, CCN 340039

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gaston Family Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Gastonia, NC
  • NPI 1215932215

  NC

  Medicare reassignment NPD
• Gaston Family Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Gastonia, NC
  • NPI 1306644315
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Iredell Memorial Hospital, Incorporated

  • General Acute Care Hospital
  • Statesville, NC
  • NPI 1417944224

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1374278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1669814513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 2ND AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524358",
            "telephone_number": "704-874-1936",
            "fax_number": "704-865-4614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 GOVERNMENT CENTER DR",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270286299",
            "telephone_number": "336-477-2233",
            "fax_number": "336-450-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "KRISTI",
        "middle_name": "MCDONALD",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-20",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP07307",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "LA",
            "license": "AP07307",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5018585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Beneke
• Leslie Payne Bentley
• Montanna Berrier
• Blu Roses Garden LLC
• Sasha Bobbitt, COF
• Teresa Marie Bowman
• Jocelyn Bradburn
• Danielle Renee Bratton, B.S. BCABA
• Bright Light Care LLC
• Bright Light Care LLC

• All providers in Mocksville, NC
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.