Provider Demographics
NPI:1326811258
Name:BOGGS, KAYLA RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEE
Last Name:BOGGS
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:RENEE
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:140 CROFT CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:TURTLETOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37391-4407
Mailing Address - Country:US
Mailing Address - Phone:423-241-2822
Mailing Address - Fax:
Practice Address - Street 1:101 RIVERSTONE VIS STE 215
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6665
Practice Address - Country:US
Practice Address - Phone:706-946-4227
Practice Address - Fax:706-258-4175
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP002798363L00000X
TN35115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner