Provider Demographics
NPI:1487441002
Name:BOVARD, KAYLEE K
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:K
Last Name:BOVARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 STARLITE LOOP UNIT E
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4110
Mailing Address - Country:US
Mailing Address - Phone:580-491-0606
Mailing Address - Fax:
Practice Address - Street 1:4840 STARLITE LOOP UNIT E
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-4110
Practice Address - Country:US
Practice Address - Phone:580-491-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN821761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse