Provider Demographics
NPI:1770283699
Name:BOGOSIAN, LISA ANN (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BOGOSIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 EXECUTIVE PARK DR STE C200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4644
Mailing Address - Country:US
Mailing Address - Phone:865-670-6700
Mailing Address - Fax:
Practice Address - Street 1:1930 ALCOA HWY STE 145
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1546
Practice Address - Country:US
Practice Address - Phone:865-305-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37485363LP0200X
TN235050163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse