Boulicault, Renee L

Boulicault, Renee L is an individual health care provider with primary practice located at 105 W Park Dr , Kingsport TN 37660-3805. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Hospitalist is her primary health care specialty. Boulicault, Renee L can be contacted via phone (423) 224-3220.

Contact Information

Primary practice address
105 W Park Dr Kingsport TN 37660-3805
Phone: (423) 224-3220
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 4868-320 Wisconsin
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 103629 Missouri
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 70768 Tennessee
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 70768 Tennessee

Profile Details

NPI number 1639148422
LBN Legal business name Boulicault, Renee L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 15th, 2006
Last updated Sep 5th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639148422 NPPES
Wisconsin MEDICAID 1639148422

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