Provider Demographics
NPI:1316989650
Name:BOVARD, KELLI SPILLERS (CPNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:SPILLERS
Last Name:BOVARD
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:MICHELLE
Other - Last Name:SPILLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:8415 GOODWOOD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7851
Mailing Address - Country:US
Mailing Address - Phone:225-925-9797
Mailing Address - Fax:225-925-9787
Practice Address - Street 1:8415 GOODWOOD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7851
Practice Address - Country:US
Practice Address - Phone:225-925-9797
Practice Address - Fax:225-925-9787
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN103455 AP04901363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1527467Medicaid
LA247935YJA2Medicare PIN