Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 09964 | OH |
N | 363LN0000X | Nurse Practitioner - Neonatal | NP09964 | OH |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | NP09964 | OH |
NPI | 1174850572 |
---|---|
Provider Name | Kelly Ann Boroff-Praul |
First Address | Nashville, TN 37214-3108 |
Second Address | Nashville, TN 37214-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2009 |
Last Update Date | 26/02/2018 |