Provider Demographics
NPI:1801972682
Name:BOGART, JAMA JELAINE (FNP)
Entity type:Individual
Prefix:
First Name:JAMA
Middle Name:JELAINE
Last Name:BOGART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JAMA
Other - Middle Name:JELAINE
Other - Last Name:FOSSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, DNP, PMHNP-BC
Mailing Address - Street 1:800 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3223
Mailing Address - Country:US
Mailing Address - Phone:417-448-3600
Mailing Address - Fax:417-448-3796
Practice Address - Street 1:345 S BARRETT LN
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-4255
Practice Address - Country:US
Practice Address - Phone:417-448-2439
Practice Address - Fax:417-549-6112
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021050610363LP0808X
MO106090363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1801972682Medicaid
718E114Medicare Oscar/Certification
MOQ52403Medicare UPIN