Boussert, Kelly Eaton
Boussert, Kelly Eaton is an individual health care provider with primary practice located at 8080 Bluebonnet Blvd Ste 1000 , Baton Rouge LA 70810-7827. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Interventional Pain Medicine is her primary health care specialty. Boussert, Kelly Eaton can be contacted via phone (225) 924-2424.Contact Information
Primary practice address
8080 Bluebonnet Blvd Ste 1000
Baton Rouge LA 70810-7827
Phone: (225) 924-2424
Fax: (225) 408-7980
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | MD.207144 | Louisiana |
| Allopathic & Osteopathic Physicians / Interventional Pain Medicine | 208VP0014X | MD.207144 | Louisiana |
Profile Details
| NPI number | 1679717136 |
|---|---|
| LBN Legal business name | Boussert, Kelly Eaton |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 28th, 2009 |
| Last updated | Jun 15th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679717136 | NPPES |
| Louisiana | MEDICAID | 1883450 |
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