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Contact Information

KEISHA M BOUDREAU, NP
9040 JACKSON AVE
TACOMA, WA98431-0001
 Phone: 253-477-9781
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Acute Care

363LA2100X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for KEISHA M BOUDREAU · (Female)

NPI # 1689471500
Status Active
Credentials NP (Nurse Practitioner)
Entity Individual
Enumeration date 02/27/2025
Last updated 02/27/2025 - More than a year ago
Sole proprietor 1 No
Identifiers
  • TX License # 1190654
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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