Provider Demographics
NPI:1730728031
Name:BOUCHER, STEPHEN ANDREW (APRN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANDREW
Last Name:BOUCHER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:104 WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3837
Mailing Address - Country:US
Mailing Address - Phone:864-725-4673
Mailing Address - Fax:864-725-7424
Practice Address - Street 1:160 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3808
Practice Address - Country:US
Practice Address - Phone:864-223-8090
Practice Address - Fax:864-223-4026
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2025-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC23405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner