Individual
HALEY TESS BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2001 2ND AVE STE 201, SUMMERVILLE, SC 29486-7887
(843) 572-4840
Mailing address
2001 2ND AVE STE 201, SUMMERVILLE, SC 29486-7887
(843) 572-4840
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3335
SC
Other
Enumeration date
08/23/2016
Last updated
11/10/2025
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