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General NPI Number Information
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NPI Number | 1649166984
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Entity Type | Organization
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Legal Business Name | HEALTH BOUTIQUE
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 606 LATIOLAIS DR UNIT A
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-4231
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Country | US
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Telephone | 337-414-6463
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Fax | 337-414-6483
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Provider Business Mailing Address
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Address Line | 203 TIMBERLAND RIDGE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70507-2746
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Country | US
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Telephone | 318-458-4523
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER/OWNER
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Name | MRS. MHYKEISHA KATRESE EVANS-GEORGE
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Credential | FNP-C
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Telephone | 318-458-4523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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