Provider Demographics
NPI:1164538187
Name:BOGE, JANICE J (ARNP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:J
Last Name:BOGE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 WOODLAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-8798
Mailing Address - Country:US
Mailing Address - Phone:620-223-8040
Mailing Address - Fax:620-223-8524
Practice Address - Street 1:403 WOODLAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-8798
Practice Address - Country:US
Practice Address - Phone:620-223-8040
Practice Address - Fax:620-223-8524
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45022363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4287244201Medicaid
KS160597BOMedicare ID - Type UnspecifiedMEDICARE NUMBER
KS4287244201Medicaid