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General NPI Number Information
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NPI Number | 1750944708
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Entity Type | Individual
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Provider Name | KATHERINE ELISABETH BOUCHARD DO
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Gender | Female
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 4161 MCKINNEY AVE STE 300
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City | DALLAS
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State | TX
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Zip | 75204-8233
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Country | US
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Telephone | 972-817-7040
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Fax |
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Provider Business Mailing Address
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Address Line | 4161 MCKINNEY AVE STE 300
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City | DALLAS
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State | TX
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Zip | 75204-8233
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Country | US
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Telephone | 972-817-7040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | BP10067050
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S9107
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License Number State | TX
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