Basic Information
| Provider Information | |||||||||
| NPI: | 1669190534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUGHTON | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 UPPER MERRIMAN DR | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443031634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304753063 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 WABASH AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303446000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2022 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 2022029383 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.