Provider Demographics
NPI:1164499661
Name:BOGGS, LINDA C (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:BOGGS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 JUDSON RD STE 900
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3922
Mailing Address - Country:US
Mailing Address - Phone:903-212-8990
Mailing Address - Fax:903-212-8973
Practice Address - Street 1:1221 JUDSON RD STE 900
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3922
Practice Address - Country:US
Practice Address - Phone:903-212-8990
Practice Address - Fax:903-212-8973
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239464363LW0102X
TXAP107327363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102263403Medicaid
TXS50156Medicare UPIN
TX409785KYRAMedicare PIN
TXTXB147408Medicare PIN