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NPI Code Detail

MEDICARE: MISS LAURA MICHELLE BOUCHER PA-C

MEDICARE: MISS LAURA MICHELLE BOUCHER PA-C
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
1363AS0400XSurgical Physician Assistant2883OK
2363A00000XPhysician AssistantPA.0005293CO

General Provider Information

NPI Number : 1770085243
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LAURA MICHELLE BOUCHER PA-C
Provider Business Mailing Address
First Line : 6600 S YALE AVE STE 1400
Second Line :
City : TULSA
State : OK
Zip : 74136-3331
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6475 S YALE AVE STE 308
Second Line :
City : TULSA
State : OK
Zip : 74136-7802
Country : US
Telephone Number : 918-499-4000
Fax Number : 918-499-4001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2018
Last Update Date : 05/19/2026

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Directions to “ MISS LAURA MICHELLE BOUCHER PA-C” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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