Provider Demographics
NPI:1902413974
Name:BOGARD, KATHARINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:BOGARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:BARICEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2032 TUILLERIES CV
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2423
Mailing Address - Country:US
Mailing Address - Phone:228-297-5857
Mailing Address - Fax:
Practice Address - Street 1:1025 DIVISION ST STE B
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2910
Practice Address - Country:US
Practice Address - Phone:228-388-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily