Provider Demographics
NPI:1457875056
Name:BOGGESS, LAURIE ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ELIZABETH
Last Name:BOGGESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4607
Mailing Address - Country:US
Mailing Address - Phone:580-272-0025
Mailing Address - Fax:580-272-6559
Practice Address - Street 1:325 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4607
Practice Address - Country:US
Practice Address - Phone:580-272-0025
Practice Address - Fax:580-272-6559
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily