Healthcare Provider Details

I. General information

NPI: 1891299541
Provider Name (Legal Business Name): AMBER BOUTWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1440 CANAL ST
NEW ORLEANS LA
70112-2703
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-2201
  • Fax:
Mailing address:
  • Phone: 225-256-4262
  • Fax: 225-960-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number328929
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: