Individual
KELLY PATRICE BOGGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 DUTCH VALLEY DR, KNOXVILLE, TN 37918-1424
(865) 689-1122
(865) 689-2923
Mailing address
PO BOX 15004, KNOXVILLE, TN 37901-5004
(865) 541-8895
(865) 633-4808
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
24699
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3077452
—
TN
Enumeration date
08/24/2006
Last updated
03/04/2019
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