Provider Demographics
NPI:1659395747
Name:BOGARDUS, MELINDA A (FNP)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:A
Last Name:BOGARDUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 MCCONNELL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9772
Mailing Address - Country:US
Mailing Address - Phone:336-246-9449
Mailing Address - Fax:336-246-8163
Practice Address - Street 1:413 MCCONNELL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9772
Practice Address - Country:US
Practice Address - Phone:336-246-9449
Practice Address - Fax:336-246-8163
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8131Medicare ID - Type Unspecified
FLS80845Medicare UPIN