Provider Demographics
NPI:1134351356
Name:BOUCHARD, KATHRYN ELIZABETH (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:BOUCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3879 E 120TH AVE # 164
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1658
Mailing Address - Country:US
Mailing Address - Phone:720-443-3490
Mailing Address - Fax:720-319-8995
Practice Address - Street 1:3879 E 120TH AVE # 164
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1658
Practice Address - Country:US
Practice Address - Phone:720-443-3490
Practice Address - Fax:720-319-8995
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10090207Q00000X, 363LF0000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily