Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Renee L Boulicault, MD

Individual provider Obstetrics & Gynecology Physician · NPI 1639148422

Dr. Renee L Boulicault, MD is an Obstetrics & Gynecology Physician in Kingsport, Tennessee. Works from 3 locations. Licensed in Missouri, Tennessee and Wisconsin.

Licensed in
MO, TN, WI
In the registry since
2006
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

105 W Park Dr
Kingsport, TN 37660-3805
Phone: (423) 224-3220
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1601 E Broadway, Columbia, MO 65201-8020 — (573) 443-8796
  • 3400 E Racine St, Janesville, WI 53546-2344 — (608) 373-8000

Specialties & licences

Hospitalist Physician (primary) Taxonomy 208M00000X · Licence 70768 (TN)
Obstetrics & Gynecology Physician Taxonomy 207V00000X · Licence 4868-320 (WI)
Obstetrics & Gynecology Physician Taxonomy 207V00000X · Licence 103629 (MO)
Obstetrics & Gynecology Physician Taxonomy 207V00000X · Licence 70768 (TN)

Record details

NPI number1639148422
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 15, 2006
Last updated in NPPESSeptember 5, 2025
Certification dateSeptember 5, 2025

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