Healthcare Provider Details

I. General information

NPI: 1407730690
Provider Name (Legal Business Name): WHITNI TIERRA BOGGS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LN STE 100
HAZARD KY
41701-9524
US

IV. Provider business mailing address

PO BOX 273
WHITESBURG KY
41858-0273
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1300
  • Fax: 606-439-1400
Mailing address:
  • Phone: 561-565-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4044714
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: