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General NPI Number Information
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NPI Number | 1134624901
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Entity Type | Individual
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Provider Name | KYLE BODEN MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 827 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-5001
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Country | US
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Telephone | 865-984-0900
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Fax | 865-984-1035
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Provider Business Mailing Address
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Address Line | 8320 E WALKER SPRINGS LN STE 200
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City | KNOXVILLE
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State | TN
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Zip | 37923-3120
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Country | US
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Telephone | 865-769-4500
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Fax | 865-769-4501
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 71179
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 71179
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License Number State | TN
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