Provider Demographics
NPI:1639379597
Name:BOGGS, KATHY (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:MT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-0022
Mailing Address - Country:US
Mailing Address - Phone:419-947-1979
Mailing Address - Fax:
Practice Address - Street 1:5986 COUNTY ROAD 93
Practice Address - Street 2:
Practice Address - City:MT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-0022
Practice Address - Country:US
Practice Address - Phone:419-647-1979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN276027163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2233112Medicaid