Provider Demographics
NPI:1124403944
Name:BOGGS, LISA M (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BOGGS
Suffix:
Gender:F
Credentials:FNP-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9238
Practice Address - Country:US
Practice Address - Phone:417-533-6746
Practice Address - Fax:417-533-6722
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2015023431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1124403944Medicaid
MO1124403944Medicaid