Individual
DR. RENEE L BOULICAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
105 W PARK DR, KINGSPORT, TN 37660-3805
(423) 224-3220
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 952-2111
(423) 282-1657
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
103629
MO
207V00000X
Obstetrics & Gynecology Physician
4868-320
WI
207V00000X
Obstetrics & Gynecology Physician
70768
TN
208M00000X
Hospitalist Physician
Primary
70768
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639148422
—
WI
Enumeration date
03/15/2006
Last updated
09/05/2025
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