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NPI Code Detail

MEDICARE: KATHERINE CHARLES GARDNER BOUGARD RN

MEDICARE: KATHERINE CHARLES GARDNER BOUGARD RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN3101HI

General Provider Information

NPI Number : 1154613743
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE CHARLES GARDNER BOUGARD RN
Provider Business Mailing Address
First Line : 1301 PUNCHBOWL ST
Second Line :
City : HONOLULU
State : HI
Zip : 96813-2402
Country : US
Telephone Number : 808-547-4221
Fax Number : 808-537-7896
Provider Business Practice Location Address
First Line : 1301 PUNCHBOWL ST
Second Line :
City : HONOLULU
State : HI
Zip : 96813-2402
Country : US
Telephone Number : 808-547-4221
Fax Number : 808-537-7896
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2011
Last Update Date : 06/22/2026

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