MEDICARE: VICKY BOEDIGHEIMER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	5456	TN
2	363A00000X	Physician Assistant	5456	TN

General Provider Information

NPI Number	:	1114481496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKY BOEDIGHEIMER

Provider Business Mailing Address
First Line	:	3803 BEDFORD AVE STE 102
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2565
Country	:	US
Telephone Number	:	615-249-4700
Fax Number	:	615-206-2345

Provider Business Practice Location Address
First Line	:	3803 BEDFORD AVE STE 102
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2565
Country	:	US
Telephone Number	:	615-249-4700
Fax Number	:	615-206-2345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	01/31/2026

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Directions to “ VICKY BOEDIGHEIMER ” Practice Location

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