Provider Demographics
NPI:1932351988
Name:BOGGS, JUDY ALLISON (ARNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ALLISON
Last Name:BOGGS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0697
Mailing Address - Country:US
Mailing Address - Phone:606-439-2662
Mailing Address - Fax:606-439-7429
Practice Address - Street 1:1908 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2505
Practice Address - Country:US
Practice Address - Phone:606-439-2662
Practice Address - Fax:606-439-7429
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4615P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015161Medicaid
KY0501432Medicare PIN
KYQ55426Medicare UPIN