MEDICARE: KATHLEEN MARY BOVEE NP

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	363LG0600X	Gerontology Nurse Practitioner	340436-1	NY
2	363LG0600X	Gerontology Nurse Practitioner	R218354	MD
3	363LG0600X	Gerontology Nurse Practitioner	11	FL
4	363LG0600X	Gerontology Nurse Practitioner	11020385	FL
5	363LG0600X	Gerontology Nurse Practitioner	340436	NY
6	163W00000X	Registered Nurse	482629-1	NY

General Provider Information

NPI Number	:	1942314265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARY BOVEE NP

Provider Business Mailing Address
First Line	:	1344 S APOLLO BLVD STE 406
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3185
Country	:	US
Telephone Number	:	321-727-2990
Fax Number	:	321-724-0455

Provider Business Practice Location Address
First Line	:	6300 N WICKHAM RD STE 132A
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-2023
Country	:	US
Telephone Number	:	321-253-4032
Fax Number	:	321-253-4125

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/12/2024

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Directions to “ KATHLEEN MARY BOVEE NP” Practice Location

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