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NPI Code Detail

MEDICARE: D'LYNN BOGER MHPP

MEDICARE:   D'LYNN  BOGER  MHPP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1245676071
Entity Type Code : Individual
Provider Name (Legal Business Name) : D'LYNN BOGER MHPP
Provider Business Mailing Address
First Line : 1309 N CHURCH ST
Second Line :
City : ATKINS
State : AR
Zip : 72823-3230
Country : US
Telephone Number : 479-641-0730
Fax Number : 479-641-0732
Provider Business Practice Location Address
First Line : 1309 N CHURCH ST
Second Line :
City : ATKINS
State : AR
Zip : 72823-3230
Country : US
Telephone Number : 479-641-0730
Fax Number : 479-641-0732
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2013
Last Update Date : 05/20/2013

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Directions to “ D'LYNN BOGER MHPP” Practice Location

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