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General NPI Number Information
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NPI Number | 1134938624
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Entity Type | Individual
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Provider Name | KACI BOSTICK APRN
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 9623 PIGLET RD
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City | FORT WORTH
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State | TX
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Zip | 76123-4066
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Country | US
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Telephone | 239-240-7014
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Fax |
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Provider Business Mailing Address
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Address Line | 6764 W STATE ROAD 78
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City | MOORE HAVEN
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State | FL
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Zip | 33471-8416
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Country | US
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Telephone | 239-240-7014
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11036609
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1189608
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License Number State | TX
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