Provider Demographics
NPI:1235643990
Name:BOUTAUGH, RACHEL (FNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BOUTAUGH
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MEDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04460-3166
Mailing Address - Country:US
Mailing Address - Phone:207-794-6700
Mailing Address - Fax:
Practice Address - Street 1:1930 MEDWAY RD
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:ME
Practice Address - Zip Code:04460-3166
Practice Address - Country:US
Practice Address - Phone:207-794-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134895363LF0000X
MECNP241177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382658802Medicaid
TX382658801Medicaid