Active NPI
Michele A Boutilier, LHIS
- Specialist
- Kill Devil Hills, NC
National Provider Identifier
1609062793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1003
- Practice address
- 2400 N. Croatoan Hwy
Suite G
Kill Devil Hills, NC 27948 - Phone
- (252) 441-2595
- Fax
- (252) 441-2595
- NPI assigned
- Sep 21, 2007
- Last updated
- Feb 25, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1003 | NC | Primary |
Addresses
Primary practice location
2400 N. Croatoan Hwy
Suite G
Kill Devil Hills, NC 27948
Mailing address
128 Acorn Lane
Point Harbor, NC 27964
Phone (252) 441-2595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003 | Other | NC | NC HEARING AID LICENSE BO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1003 | NC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424822400000",
"number": "1609062793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 ACORN LANE",
"city": "POINT HARBOR",
"state": "NC",
"postal_code": "27964",
"telephone_number": "252-441-2595",
"fax_number": "252-441-2595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 N. CROATOAN HWY",
"address_2": "SUITE G",
"city": "KILL DEVIL HILLS",
"state": "NC",
"postal_code": "27948",
"telephone_number": "252-441-2595",
"fax_number": "252-441-2595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUTILIER",
"first_name": "MICHELE",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "LHIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-21",
"last_updated": "2015-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NC",
"license": "1003",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC HEARING AID LICENSE BO",
"identifier": "1003",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kill Devil Hills, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.