Provider Demographics
NPI:1982112124
Name:BOYCHUK, KATIE MICHELLE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MICHELLE
Last Name:BOYCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 INDEPENDENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-4600
Mailing Address - Country:US
Mailing Address - Phone:214-389-8801
Mailing Address - Fax:214-389-8802
Practice Address - Street 1:5560 INDEPENDENCE PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4600
Practice Address - Country:US
Practice Address - Phone:214-389-8801
Practice Address - Fax:214-389-8802
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134938363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics