Healthcare Provider Details

I. General information

NPI: 1366589830
Provider Name (Legal Business Name): KAYE W BORGOGNONI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8071 WINCHESTER RD
MEMPHIS TN
38125-8206
US

IV. Provider business mailing address

PO BOX 1000 SUITE 38
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-756-6056
  • Fax: 901-624-0702
Mailing address:
  • Phone: 901-756-6056
  • Fax: 901-624-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000012308
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: