Healthcare Provider Details

I. General information

NPI: 1053232058
Provider Name (Legal Business Name): MARCUS BOUTTE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 JEFFERSON ST
LAFAYETTE LA
70501
US

IV. Provider business mailing address

1492 BAYOU FUSELIER RD
ARNAUDVILLE LA
70512-3100
US

V. Phone/Fax

Practice location:
  • Phone: 337-703-6500
  • Fax:
Mailing address:
  • Phone: 337-303-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number248485
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: