Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Emily Brooke Boucher, PA-C

Individual provider Physician Assistant · NPI 1255933263

Emily Brooke Boucher, PA-C is a Physician Assistant in Kettering, Ohio. Qualified in 2020, 6 years ago. Practices with Kettering Independent Medical Group Inc, a 700-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Ohio.

Years since qualifying
6
Licensed in
OH
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3737 Southern Blvd Boonshoft Bld Fl E
Kettering, OH 45429
Phone: (937) 294-1489
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 50.006744RX
Physician Assistant Taxonomy 363A00000X · Licence 1160683 (OH)

Record details

NPI number1255933263
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedNovember 13, 2020
Last updated in NPPESMarch 8, 2021
Certification dateMarch 8, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Kettering Independent Medical Group Inc — 700 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations7 on file with Medicare

Other providers in Kettering