Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Nicholas Boullard, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1811492309

Nicholas Boullard, MD is a Student in an Organized Health Care Education/Training Program in Jackson, Mississippi. Works from 2 locations. Licensed in Mississippi.

Licensed in
MS
In the registry since
2018
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4026 N State St
Jackson, MS 39206-5754
Phone: (601) 813-3446
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1514 Jefferson Hwy, Jefferson, LA 70121-2429 — (866) 624-7637

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X · Licence 28006 (MS)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1811492309
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 27, 2018
Last updated in NPPESAugust 11, 2021
Certification dateAugust 11, 2021
Mailing address4026 N State St, Jackson, MS 39206-5754

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