Provider Demographics
NPI:1942314265
Name:BOVEE, KATHLEEN MARY (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:BOVEE
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1344 S APOLLO BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3185
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:6300 N WICKHAM RD STE 132A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2023
Practice Address - Country:US
Practice Address - Phone:321-253-4032
Practice Address - Fax:321-253-4125
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340436-1363LG0600X
MDR218354363LG0600X
FL11363LG0600X
FL11020385363LG0600X
NY340436363LG0600X
NY482629-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP07562Medicare UPIN
P07562Medicare UPIN
NYP07562Medicare UPIN