Provider Demographics
NPI:1205393741
Name:BOGGS, NATHAN (APRN NP-C)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:BOGGS
Suffix:
Gender:M
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-9391
Mailing Address - Country:US
Mailing Address - Phone:304-525-2273
Mailing Address - Fax:304-525-2165
Practice Address - Street 1:1115 20TH ST STE 107
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-0003
Practice Address - Country:US
Practice Address - Phone:304-691-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN63231-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1205393741Medicaid
OH0344597Medicaid
KY7100597160Medicaid