Douglas Allen Bouldin, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

113431 Issued in MO

Practice address

13353 Olive Blvd
Chesterfield, MO 63017-3108

Phone

(636) 473-8873

NPI assigned

Dec 13, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Lincoln County Memorial Hospital

  • Internal Medicine Physician
  • Troy, MO
  • NPI 1407260961
  NPD (past)

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458086400000",
    "number": "1770568727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13353 OLIVE BLVD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173108",
            "telephone_number": "636-473-8873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13353 OLIVE BLVD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173108",
            "telephone_number": "636-473-8873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDIN",
        "first_name": "DOUGLAS",
        "middle_name": "ALLEN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2016-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "113431",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3009332",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425690617",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janet B Bordenave, LMFT
• Catherine Zaegel Born, PT, DPT
• Prairie J Boschulte, LPC
• Chase Boucher, PHARMD
• Morgan Boudreau, NP
• Katherine Bourgerie
• Michelle Bourke
• Bourn and Associates, P.C.
• Pamela Boutaugh
• Kaylea Marie Boutwell, M.D.

• Nurse Practitioner in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; 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.