Healthcare Provider Details

I. General information

NPI: 1992267272
Provider Name (Legal Business Name): LARA HUTCHINSON BOUDREAUX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 HIGHWAY 190 EAST SERVICE RD STE 102
COVINGTON LA
70433-4960
US

IV. Provider business mailing address

16061 DOCTORS BLVD STE B
HAMMOND LA
70403-1499
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-9592
  • Fax:
Mailing address:
  • Phone: 985-542-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number330834
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: