# KINMED, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992206155
- **Authorized official:** DR. LYETTE BOUCHER DC (PRESIDENT)
- **Authorized official phone:** (239) 948-1222

## Contact information

- **Practice address:** 19910 S TAMIAMI TRL STE C, ESTERO, FL 33928-4140
- **Practice address phone:** (239) 948-1222
- **Practice address fax:** (239) 948-1220
- **Mailing address:** 19910 S TAMIAMI TRL STE C, ESTERO, FL 33928-4140
- **Mailing address phone:** (239) 948-1222
- **Mailing address fax:** (239) 948-1220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | FL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | FL | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | FL | — |

## Other

- **Enumeration date:** 02/23/2018
- **Last updated:** 02/23/2018