Provider Demographics
NPI:1851867238
Name:BOGGS, MELANIE SHANELL (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:SHANELL
Last Name:BOGGS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 BROADWAY EXT STE 204
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6303
Mailing Address - Country:US
Mailing Address - Phone:405-419-5926
Mailing Address - Fax:405-419-5905
Practice Address - Street 1:9800 BROADWAY EXT STE 204
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6303
Practice Address - Country:US
Practice Address - Phone:405-419-5926
Practice Address - Fax:405-419-5905
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK110497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1851867238Medicaid