Provider Demographics
NPI:1750781027
Name:BOGGS, SCOTT G (FNP-BC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:BOGGS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FAIRLAND DR
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1186
Mailing Address - Country:US
Mailing Address - Phone:304-204-2430
Mailing Address - Fax:304-397-6740
Practice Address - Street 1:40 FAIRLAND DR
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1186
Practice Address - Country:US
Practice Address - Phone:304-204-2430
Practice Address - Fax:304-397-6740
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV68576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily