Provider Demographics
NPI:1932709961
Name:BOGGS, TAMMY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8704
Mailing Address - Country:US
Mailing Address - Phone:319-230-9157
Mailing Address - Fax:
Practice Address - Street 1:509 W 1ST ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-4336
Practice Address - Country:US
Practice Address - Phone:903-401-8958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP58191164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse