Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 9445 | CT |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9445 | CT |
NPI | 1013507110 |
---|---|
Provider Name | Katelin Ashley Bouchard |
First Address | Bristol, CT 06010-3859 |
Second Address | Bristol, CT 06010-3859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2021 |
Last Update Date | 26/02/2021 |