Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1811492309 Individual Practitioner Male Practitioner

Dr. Nicholas Boullard , MD

General Practice • Jackson, MS

Professional Overview & Biography Verified Profile Summary

Dr. Nicholas Boullard, MD is a registered healthcare professional specializing in General Practice in Jackson, MS. Practice services are available at 4026 N STATE ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4026 N State St

Jackson, MS 392065754

Telephone 6018133446

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Jackson, MS

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 46.0 Yrs
State Avg: 27.8 Yrs
Regional Practice Density
7 Specialists

Practicing in Jackson, MS (91 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2021-08-11
General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License MS 28006

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Secondary Practice Locations

1514 Jefferson Hwy

Jefferson, LA 701212429

Phone: 8666247637

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 11, 2021

Student in an Organized Health Care Education/Training Program

📍
Updated Practice Location August 09, 2021

Registered at 4026 N STATE ST, JACKSON, MS 392065754 (Tel: 6018133446)

📍
Updated Business Mailing Address August 09, 2021

Registered at 4026 N STATE ST, JACKSON, MS 392065754

👤
Provider Name / Credentials Updated August 09, 2021

Recorded as NICHOLAS BOULLARD, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 09, 2021

General Practice (License #28006 in MS)

NPI Profile Active March 27, 2018

NPI status registered as active in NPPES database

📍
Updated Practice Location March 27, 2018

Registered at 1514 JEFFERSON HWY, JEFFERSON, LA 701212429 (Tel: 8666247637)

📍
Updated Business Mailing Address March 27, 2018

Registered at 4740 S I 10 SERVICE RD W STE 120, METAIRIE, LA 700011214 (Tel: 5049885458)

👤
Provider Name / Credentials Updated March 27, 2018

Recorded as NICHOLAS BOULLARD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 27, 2018

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration March 27, 2018

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1811492309
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 27, 2018
Last Update: August 11, 2021
Sole Proprietor: No

Mailing Address

4026 N State St

Jackson, MS 392065754

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.