Provider Demographics
NPI:1841451168
Name:BOGIE, HETTY KATHLEEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:HETTY
Middle Name:KATHLEEN
Last Name:BOGIE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 BANDERA HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-9515
Mailing Address - Country:US
Mailing Address - Phone:830-895-7755
Mailing Address - Fax:830-895-7757
Practice Address - Street 1:1331 BANDERA HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9515
Practice Address - Country:US
Practice Address - Phone:830-895-7755
Practice Address - Fax:830-895-7757
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX747538363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197766201Medicaid
TX197766201Medicaid