Kelly Patrice Boggan
Pediatrician
1400 Dutch Valley Dr
Knoxville
, Tennessee 37918-1424
Kelly Patrice Boggan
Pediatrician
1400 Dutch Valley Dr
Knoxville
, Tennessee 37918-1424
(865) 633-4808
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About
Features
Specialties
- Pediatrician
Languages spoken
- English
Location
First Address
- Kelly Patrice Boggan
- Po Box 15004
- Knoxville, TN
- Zip : 37901-5004
- Fax : (865) 633-4808
- Phone : (865) 541-8895
Second Address
- Kelly Patrice Boggan
- 1400 Dutch Valley Dr
- Knoxville, TN
- Zip : 37918-1424
- Fax : (865) 689-2923
- Phone : (865) 689-1122
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208000000X | Pediatrician | 24699 | TN |
National Provider Identifier
| NPI | 1003923962 |
|---|---|
| Provider Name | Kelly Patrice Boggan |
| First Address | Knoxville, TN 37901-5004 |
| Second Address | Knoxville, TN 37918-1424 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/08/2006 |
| Last Update Date | 04/03/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 3077452 | (05) | TN |
| F64796 | (02) | TN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.