Provider Demographics
NPI:1427017904
Name:BOGART, KIMBERLY R (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:BOGART
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 MIDWEST DR.
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66111
Mailing Address - Country:US
Mailing Address - Phone:913-745-1930
Mailing Address - Fax:913-745-1935
Practice Address - Street 1:2601 MIDWEST DR.
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111
Practice Address - Country:US
Practice Address - Phone:913-745-1930
Practice Address - Fax:913-745-1935
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1124363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP60716Medicare UPIN
OK249235002Medicare ID - Type Unspecified