Katelyn Bouthillier

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1760205264 Issued in NC

Practice address

404 S Sutherland Ave
Monroe, NC 28112-5060

Phone

(704) 291-9267

NPI assigned

Nov 4, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• First Care Medical Clinic, PA

  • Internal Medicine Physician
  • Monroe, NC
  • NPI 1689635237

  NC

  Medicare reassignment

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

{
    "created_epoch": "1730678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1760205264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 S SUTHERLAND AVE",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281125060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 S SUTHERLAND AVE",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281125060",
            "telephone_number": "704-291-9267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTHILLIER",
        "first_name": "KATELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-04",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "1760205264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cara Bonwell-Orr, LCSW
• Thomas Daulton Bopp, MD
• Reagan Borden
• Leandro Boryczewski, MS
• Nader Boulos, MD
• Edward Birch Bower, MD
• Gwendolyn D Bowman, SLP
• Tarra Marsh Boyd, FNP
• John Robert Bradey Jr., PH.D.
• Haley Bradley, LMFTA

• All providers in Monroe, NC
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.