Provider Demographics
NPI:1568067866
Name:IENG, BORANY KIM (DNP, APRN)
Entity Type:Individual
Prefix:DR
First Name:BORANY
Middle Name:KIM
Last Name:IENG
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 OAK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6410
Mailing Address - Country:US
Mailing Address - Phone:901-604-9432
Mailing Address - Fax:
Practice Address - Street 1:671 N ERICSON RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-1006
Practice Address - Country:US
Practice Address - Phone:901-757-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28334363LP0808X, 363LF0000X
TN212038363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily