Individual
EMILY BROOKE BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3737 SOUTHERN BLVD, BOONSHOFT BLD. FLOOR E, KETTERING, OH 45429
(937) 294-1489
Mailing address
1 PRESTIGE PL STE 550, MIAMISBURG, OH 45342-6115
(937) 762-1306
(937) 522-7017
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1160683
OH
363A00000X
Physician Assistant
Primary
50.006744RX
—
Other
Enumeration date
11/13/2020
Last updated
03/08/2021
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