DR. KENT ANDREW BOUCHER (NPI# 1144725755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144725755 |
| Entity Type | Individual |
| Full Name | DR. KENT ANDREW BOUCHER |
| Credential | M.D. |
| Practice Address |
27th Special Operations Medical Group 224 W Dl Ingram Ave Cannon Afb NM 88103-5103 |
| Practice Telephone | 5759043917 |
| Practice Fax Number | 5757846028 |
| Mailing Telephone | 5759043917 |
| Mailing Fax Number | 5757846028 |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2019-10-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | S2734 | TX | Allopathic & Osteopathic Physicians |
| Street Address |
27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W DL INGRAM AVE |
| City | CANNON AFB |
| State | NM |
| Zip Code | 88103-5103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972833523 | Deborah J Angeles | Nurse Practitioner | 27th Special Operations Medical Group, 224 W Dl Ingram Ave, Cannon Afb, NM 88103-5103 | 2010-01-04 |
| 1649814120 | Chase Chesterman | Dietitian, Registered | 27th Special Operations Medical Group, 224 W Dl Ingram Ave, Cannon Afb, NM 88103-5103 | 2019-10-29 |
| 1134613342 | Nicholas F Polk | Social Worker | 27th Special Operations Medical Group, 224 W D.l. Ingram Ave, Cannon Afb, NM 88103-5103 | 2018-06-20 |
| 1184137218 | Racheal L Rivera | Nurse Practitioner | 27th Special Operations Medical Group, 27 Somdg/sghc, Cannon Afb, NM 88103-5103 | 2017-11-11 |
| 1821510033 | Wallace D Cleveland Jr. | Physician Assistant | 27th Special Operations Medical Group, 224 W D.l. Ingram Ave, Cannon Afb, NM 88103-5103 | 2017-07-10 |
| 1497104194 | Anne M Murphy | Pediatrics | 27th Special Operations Medical Group, 224 W Dl Ingram Ave, Cannon Afb, NM 88103-5103 | 2016-06-03 |
| 1265848576 | John M Richardson | Family Medicine | 27th Special Operations Medical Group, 244 W D.l. Ingram Ave, Cannon Afb, NM 88101-5103 | 2014-07-08 |
| 1710287362 | Julie A Thomas | Nurse Practitioner | 27th Special Operations Medical Group, 224 W Dl Ingram Ave, Cannon Afb, NM 88103-5103 | 2010-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346747151 | Isabella Wolak | Pharmacist | 224 D L Ingram Blvd, Cannon Afb, NM 88103 | 2018-04-09 |
| 1225480544 | Stacey Tatro | Dentist | 224 West D.l. Ingram Ave., Bldg 1408, Cannon Afb, NM 88103 | 2016-07-11 |
| 1871965673 | Chad Bryan Carter | Dentist | 224 W Dl Ingram Ave, Sgpd/dental Clinic, Cannon Air Force Base, NM 88103 | 2015-10-20 |
| 1740660836 | Terah Clifford | Dental Hygienist | 224 W Dl Ingram Blvd, Bldg 1408 Dental Clinic, Cannon Afb, NM 88103 | 2015-06-03 |
| 1528452208 | Taylor Bottari | Physician Assistant | 208 W Dl Ingram, Cannon Afb, NM 88103 | 2015-03-20 |
| 1588071328 | Gretchen Evelynn Szymanski | Nurse Practitioner | Cannon Afb, 224 W D.l. Ingram Blvd, Cannon Afb, NM 88103 | 2014-07-14 |
| 1396155206 | Jennifer Brynn Bendokas | Physician Assistant | 224 West Dl Ingram Avenue, Cannon Afb, NM 88103 | 2014-04-30 |
| 1366889487 | Jeremy Michael Strohmayer | General Practice | 511 Chindt Blvd Building 300, 27soss/osm, Cannon Afb, NM 88103 | 2013-05-30 |
| 1356622401 | Matthew John Nielsen | Dentist | 224 W D.l. Ingram, Bld. 1408, Cannon Afb, NM 88103 | 2011-09-02 |
| 1689965485 | Bryan Wade Sixkiller | Optometrist | 27th Somdg, 208 W. Casa Blanca Ave., Apo, AA 88103 | 2011-04-27 |
| Find all providers in zip 88103 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366889487 | Jeremy Michael Strohmayer | General Practice | 511 Chindt Blvd Building 300, 27soss/osm, Cannon Afb, NM 88103 | 2013-05-30 |
| 1184920787 | John Michael Peffer | General Practice | 511 N Torch Blvd Bldg 300, Cannon Afb, NM 88103-5109 | 2011-01-31 |
| 1871721837 | William D. Smith | General Practice | 224 W D L Ingraham, Cannon Afb, NM 88103 | 2009-06-29 |
| 1568690113 | Justin D Sterett | General Practice | 27 Somdg 208 W. Casablanca Ave Bldg 1400, Cannon Afb, NM 88103 | 2009-06-22 |
| 1700172723 | Carissa Sherrit | General Practice | 511 N Torch Blvd Bldg 300, 27 Soss/osm, Cannon Afb, NM 88103-5109 | 2011-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616679 | Gemma Cristina Zapater | General Practice | 923 Calle Fuerte Ne, Albuquerque, NM 87113-2373 | 2020-10-15 |
| 1710596036 | Provider Cares Network LLC | General Practice | 10401 Montgomery Pkwy Ne Ste 1a, Albuquerque, NM 87111-3876 | 2020-07-23 |
| 1154948081 | Designed Health Options, LLC | General Practice | 5065 Corrales Rd., Corrales, NM 87048 | 2020-06-26 |
| 1538714381 | Uyama A Fernandez | General Practice | 400 Gold Ave Sw Ste 220, Albuquerque, NM 87102-3278 | 2019-08-08 |
| 1386180909 | Lisselle Marie Villarrubia Ocasio | General Practice | Msc10 6000 1 University of New Mexico, Albuquerque, NM 87131-5505 | 2017-01-07 |
| 1225586969 | Joan Goldsworthy | General Practice | Unm School of Medicine Msc09 5040, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2016-09-12 |
| 1033568902 | Karen Griest | General Practice | 68 Pinon Trl, Cedar Crest, NM 87008-9444 | 2016-06-10 |
| 1447610886 | Sean T Mcgee | General Practice | Univeristy of New Mexico, Albuquerque, NM 87131-0001 | 2016-02-27 |
| 1275901266 | Lynn Schrader Sweeney | General Practice | 701 Kerney Dr, Farmington, NM 87401-3660 | 2015-09-08 |
| 1942608708 | Marathon Health, Inc. | General Practice | 2208 W Main St, C/o Concho Employee Health Center, Artesia, NM 88210-3720 | 2014-12-10 |
| Find all providers with the same taxonomy | ||||
| City | CANNON AFB |
| Zip Code | 88103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.