Healthcare Provider Details

I. General information

NPI: 1265912141
Provider Name (Legal Business Name): KATHRYN LYNN ARMENTOR BOUTTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 W CONGRESS ST STE 3300
LAFAYETTE LA
70506-6789
US

IV. Provider business mailing address

PO BOX 919229
DALLAS TX
75391-9229
US

V. Phone/Fax

Practice location:
  • Phone: 337-703-4481
  • Fax: 337-703-4484
Mailing address:
  • Phone: 337-289-8944
  • Fax: 337-571-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO9751
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: