Provider Demographics
NPI:1568496883
Name:BOGART, MEGAN E (PSYCH-MH NP -C)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:E
Last Name:BOGART
Suffix:
Gender:F
Credentials:PSYCH-MH NP -C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:BOGART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4300 SAPPHIRE CT 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9079
Mailing Address - Country:US
Mailing Address - Phone:252-830-7561
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:130 EDINBURGH SOUTH DR
Practice Address - Street 2:SUITE 208
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7902
Practice Address - Country:US
Practice Address - Phone:919-467-4745
Practice Address - Fax:919-467-5299
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001131207Q00000X, 363LF0000X
NC0050-01131363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592586Medicare ID - Type UnspecifiedMEDICARE#