IndividualActive
Carly Bourgeois
NPI 1154095479 · Physician Assistant · Zachary, LA
Provider details
- NPI number
- 1154095479
- Entity type
- Individual
- Primary specialty
- Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Female
- Sole proprietor
- No
- License
- 328269 (LA)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
6300 Main St
Zachary, LA 70791-4037
Phone: (225) 765-7163
Approximate (ZIP-level) locationGet directions
Mailing address
6300 Main St
Zachary, LA 70791-4037
Registry dates
- Enumerated
- 2021-08-02
- Last updated
- 2021-08-02
- Certified
- 2021-08-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.