Provider Demographics
NPI:1417480427
Name:BOUCHARD, LINDSAY ANN (DNP, PMHNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ANN
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, RN
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:CAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3939 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-1635
Mailing Address - Country:US
Mailing Address - Phone:520-333-4320
Mailing Address - Fax:
Practice Address - Street 1:1260 S CAMPBELL AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-0502
Practice Address - Country:US
Practice Address - Phone:520-407-5400
Practice Address - Fax:520-407-5990
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health