Boudreaux, Kenny Joseph
Boudreaux, Kenny Joseph is an individual health care provider with primary practice located at 3407 Shamrock Ct , Gautier MS 39553-6429. He recently has only one registered license in Other Service Providers / Case Manager/Care Coordinator, which is considered as his primary health care specialty. Boudreaux, Kenny Joseph can be contacted via phone (228) 497-0690.Contact Information
Primary practice address
3407 Shamrock Ct
Gautier MS 39553-6429
Phone: (228) 497-0690
Fax: (228) 497-1363
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Case Manager/Care Coordinator | 171M00000X |
Profile Details
| NPI number | 1750606646 |
|---|---|
| LBN Legal business name | Boudreaux, Kenny Joseph |
| Credentials | BA. B.S. PSYCHOLOGY |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 2nd, 2010 |
| Last updated | Apr 2nd, 2010 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750606646 | NPPES |
| Mississippi | MEDICAID | 00018214 |
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