Provider Demographics
NPI:1285944769
Name:BOUCHARD, DARCIE ELLEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DARCIE
Middle Name:ELLEN
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DARCIE
Other - Middle Name:ELLEN
Other - Last Name:EMGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N RAINBOW BLVD SUITE 203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107
Mailing Address - Country:US
Mailing Address - Phone:702-259-1228
Mailing Address - Fax:702-433-2477
Practice Address - Street 1:500 N RAINBOW BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107
Practice Address - Country:US
Practice Address - Phone:702-259-1228
Practice Address - Fax:702-433-2477
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR153222363A00000X
NVPA1312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500629170OtherDMAP/DEPARTMENT OF HUMAN SERVICES
OR69568060OtherBLUE CROSS BLUE SHIELD
OR500629170OtherDMAP/DEPARTMENT OF HUMAN SERVICES
NVGG225ZMedicare PIN