Individual
KELLIE BOEGGEMAN DEARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
885 3RD AVE FL 28, NEW YORK, NY 10022-4834
(929) 650-3990
Mailing address
16706 NE 98TH ST, VANCOUVER, WA 98682-1275
(803) 888-2299
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
248427
NC
363L00000X
Nurse Practitioner
Primary
APN355
SC
363LF0000X
Family Nurse Practitioner
9165739
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006413
—
NC
05
—
NP1310
—
SC
Enumeration date
08/01/2007
Last updated
04/23/2025
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