DR. KELLY DAVENPORT BOULDEN M.D.
NPI 1407820624
Family Medicine in Fort Worth, TX

Q: What is Kelly Boulden's NPI number?

The NPI number for Kelly Boulden is 1407820624. It was assigned to this individual provider in the NPPES registry on February 14, 2006.

Q: What is Kelly Boulden's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: Is Kelly Boulden enrolled in Medicare?

No. Kelly Boulden has opted out of Medicare through January 9, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Kelly Boulden was last updated on October 13, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 14, 2006Opted out of Medicare · through Jan 9, 2028

4521 S HULEN ST, SUITE 200, FORT WORTH, TX 76109(817) 924-5252(817) 924-6060 Get Directions Write a Review

NPPES record last updated: October 13, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Kelly Davenport Boulden M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY DAVENPORT BOULDEN M.D. (NPI 1407820624) is an individual family medicine provider in Fort Worth, Texas, licensed in Texas (L4258) and active in the NPI registry since February 2006. She has opted out of Medicare through January 9, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1407820624

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameDR. KELLY DAVENPORT BOULDENCredential: M.D.

Location Address4521 S HULEN ST, SUITE 200Fort Worth, TX 76109-4948

Mailing Address4521 S Hulen St, Suite 200Fort Worth, TX 76109-4948 · (817) 924-5252 · Fax (817) 924-6060

Phone(817) 924-5252

Fax(817) 924-6060

Sole ProprietorNo

Enumeration DateFebruary 14, 2006

Last NPPES UpdateOctober 13, 2008

✔ NPI 1407820624 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in TX · L4258

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

4521 S HULEN ST, Fort Worth, TX 76109

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Kelly Davenport Boulden M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 9, 2018 through January 9, 2028.

Opt-Out Effective DateJanuary 9, 2018

Opt-Out In Effect ThroughJanuary 9, 2028Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 76109 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.20 typical visit price

range $56.47 – $171.07

Typical copayment $21.80 (range $14.11 – $42.76)

Most-billed visit code 99203

Established Patient

$99.68 typical visit price

range $18.18 – $139.68

Typical copayment $24.92 (range $4.54 – $34.92)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TIMOTHY SCOTT KNIGHT D.D.S.

Dentist (General Practice)

4521 S HULEN ST, SUITE 114
FORT WORTH, TX 76109

Tarrant County (817) 924-4595

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Boulden's NPI number?

The NPI number for Kelly Boulden is 1407820624. It was assigned to this individual provider in the NPPES registry on February 14, 2006.

Where is Kelly Boulden located?

Kelly Boulden practices at 4521 S Hulen St Suite 200, Fort Worth, TX 76109. The listed phone number is (817) 924-5252.

What is Kelly Boulden's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Kelly Boulden enrolled in Medicare?

No. Kelly Boulden has opted out of Medicare through January 9, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Kelly Boulden was last updated on October 13, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.