Tyler Zachary Bouchard

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000038516 Issued in SC

Practice address

1302 Heyward St
Columbia, SC 29208-3407

Phone

(262) 765-1267

NPI assigned

Aug 3, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1508530551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 S MORELAND BLVD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531884912",
            "telephone_number": "262-765-1267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 HEYWARD ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292083407",
            "telephone_number": "262-765-1267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHARD",
        "first_name": "TYLER",
        "middle_name": "ZACHARY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-03",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "2000038516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Columbia",
            "affiliation": "N",
            "endpointDescription": "City",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1302 Heyward St",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292083407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tisha Smith Boston, MD
• Meagan Boswell
• Carlos Santiago Botero Suarez, MD
• Peter Botrous, MD
• Jennifer Bouchard
• Anna L Bouknight, MD
• Gayla Denise Bouknight
• James Gilder Bouknight, M.D.
• Jeffrey Bouknight
• Ariel Bouldin, RBT

• All providers in Columbia, SC
• Athletic Trainer in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.