Provider Demographics
NPI:1629527635
Name:BOGGIO, MELISSA ANN (PNP-AC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:BOGGIO
Suffix:
Gender:F
Credentials:PNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 CHERRY LANE FARM DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6474
Mailing Address - Country:US
Mailing Address - Phone:505-235-0392
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-6474
Practice Address - Country:US
Practice Address - Phone:859-218-2522
Practice Address - Fax:859-323-3918
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016508363LP0200X, 363LP0222X
MNCNP 4822363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics