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General NPI Number Information
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NPI Number | 1770283699
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Entity Type | Individual
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Provider Name | LISA ANN BOGOSIAN NP
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Gender | Female
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1930 ALCOA HWY STE 145
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City | KNOXVILLE
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State | TN
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Zip | 37920-1546
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Country | US
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Telephone | 865-305-6650
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 EXECUTIVE PARK DR STE C200
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City | KNOXVILLE
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State | TN
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Zip | 37923-4644
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Country | US
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Telephone | 865-670-6700
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 37485
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 235050
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License Number State | TN
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