Provider Demographics
NPI:1780950055
Name:BOUCHER, ANDREA MARIE (DNP, MSN, CNM)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:DNP, MSN, CNM
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:THRONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3025 CHAPEL WOODS CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-2505
Mailing Address - Country:US
Mailing Address - Phone:901-517-3704
Mailing Address - Fax:
Practice Address - Street 1:7800 WOLF TRAIL CV
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1753
Practice Address - Country:US
Practice Address - Phone:901-682-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016453367A00000X
GARN237911367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty