Provider Demographics
NPI:1750944708
Name:BOUCHARD, KATHERINE ELISABETH (DO)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ELISABETH
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4161 MCKINNEY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8233
Mailing Address - Country:US
Mailing Address - Phone:972-817-7040
Mailing Address - Fax:
Practice Address - Street 1:4161 MCKINNEY AVE STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8233
Practice Address - Country:US
Practice Address - Phone:972-817-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10067050207Q00000X
TXS9107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine