JUSTIN KYLE BOUDREAUX
NPI 1255847463
Counselor - Professional in Joplin, MO
About Justin Kyle Boudreaux NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JUSTIN KYLE BOUDREAUX (NPI 1255847463) is an individual professional provider in Joplin, Missouri, licensed in Missouri (2017036049) and active in the NPI registry since December 2017. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Justin Kyle Boudreaux is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 19
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
JOPLIN, MO 64804
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Justin Boudreaux's NPI number?
The NPI number for Justin Boudreaux is 1255847463. It was assigned to this individual provider in the NPPES registry on December 26, 2017.
Where is Justin Boudreaux located?
Justin Boudreaux practices at 530 E 34th St, Joplin, MO 64804. The listed phone number is (417) 347-7600.
What is Justin Boudreaux's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Justin Boudreaux enrolled in Medicare?
Yes. Justin Boudreaux is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Justin Boudreaux was last updated on December 26, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Justin Kyle Boudreaux · NPI 1255847463
Professional provider in Joplin, Missouri. Individual provider, active in the CMS NPPES registry since December 26, 2017.
## Identity
- **NPI:** 1255847463 (Entity type: Individual)
- **Enumerated:** December 26, 2017
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 2017036049 (Missouri)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 530 E 34TH ST, Joplin, MO 64804-3926
- **Phone:** (417) 347-7600
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
## Record status
- **NPPES last updated:** December 26, 2017
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Source: [NPI Profile](https://npiprofile.com/npi/1255847463) · Data from the CMS NPPES public registry.