Provider Demographics
NPI:1225464654
Name:BOUTIN, JULIE ANGELE (APN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANGELE
Last Name:BOUTIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 S RIFE MEDICAL LN STE 130
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1455
Mailing Address - Country:US
Mailing Address - Phone:479-338-5555
Mailing Address - Fax:479-338-5533
Practice Address - Street 1:1371 I-49 SOUTH SERVICE RD
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584
Practice Address - Country:US
Practice Address - Phone:337-678-4167
Practice Address - Fax:877-278-8499
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily