Provider Demographics
NPI:1013189059
Name:BOGGS, KELLI L (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:L
Last Name:BOGGS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4576 JETTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEIVASY
Mailing Address - State:WV
Mailing Address - Zip Code:26676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 NORTH HILL ROAD
Practice Address - Street 2:BRAXTON COUNTY BOARD OF EDUCATION
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601
Practice Address - Country:US
Practice Address - Phone:304-765-7101
Practice Address - Fax:304-765-7148
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52718163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool