Provider Demographics
NPI:1477939825
Name:BOGAR, KIMBERLY N (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:BOGAR
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3006
Mailing Address - Country:US
Mailing Address - Phone:304-235-0026
Mailing Address - Fax:304-235-0028
Practice Address - Street 1:1609 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3006
Practice Address - Country:US
Practice Address - Phone:304-235-0026
Practice Address - Fax:304-235-0028
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1107444OtherRN
KY3009592OtherAPRN
WV94824OtherAPRN/RN